Provider Demographics
NPI:1275554115
Name:BULETTE, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BULETTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0733
Mailing Address - Country:US
Mailing Address - Phone:757-442-2504
Mailing Address - Fax:757-442-9099
Practice Address - Street 1:10150 ROGERS DR
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413-0733
Practice Address - Country:US
Practice Address - Phone:757-442-2504
Practice Address - Fax:757-442-9099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010510102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA068468OtherVALUE OPTIONS
VA089844OtherSENTARA
VA265784OtherMAMSI
VA265784OtherMDIPA
VA265784OtherALLIANCE,PPO
VA214354OtherANTHEM BC BS
VA214354OtherHEALTHKEEPERS PLUS
VA265784OtherOPTIMUM CHOICE
VA214354OtherHEALTHKEEPERS