Provider Demographics
NPI:1245427251
Name:BULLOCK, DAVID WILLETT (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLETT
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1732
Mailing Address - Country:US
Mailing Address - Phone:785-856-5440
Mailing Address - Fax:785-856-5441
Practice Address - Street 1:3001 CARRINGTON LN
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1732
Practice Address - Country:US
Practice Address - Phone:785-856-5440
Practice Address - Fax:785-856-5441
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS531368208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSBB9278284OtherKS DRUG ENFORCEMENT AGENC
KSI132844Medicare UPIN