Provider Demographics
NPI:1164007589
Name:BULLARD, ROBERT E (HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BULLARD
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 STILLWATER AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3633
Mailing Address - Country:US
Mailing Address - Phone:207-945-5519
Mailing Address - Fax:
Practice Address - Street 1:753 STILLWATER AVE STE 7
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3633
Practice Address - Country:US
Practice Address - Phone:207-945-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL401237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist