Provider Demographics
NPI:1134482532
Name:BULLOCK, MARK JEFFREY (DPM)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JEFFREY
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1447 NORTH HARRISON
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602
Mailing Address - Country:US
Mailing Address - Phone:989-799-5557
Mailing Address - Fax:989-799-5557
Practice Address - Street 1:5483 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6037
Practice Address - Country:US
Practice Address - Phone:989-583-5626
Practice Address - Fax:989-583-1837
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2023-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002436213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery