Provider Demographics
NPI:1285637843
Name:BULLER, DAVID WARREN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WARREN
Last Name:BULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 610393
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75261-0393
Mailing Address - Country:US
Mailing Address - Phone:903-291-6187
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:602 N TITUS
Practice Address - Street 2:SUITE 120
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644
Practice Address - Country:US
Practice Address - Phone:903-843-5585
Practice Address - Fax:903-843-5587
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2019-09-20
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-10-18
Provider Licenses
StateLicense IDTaxonomies
TXH3446207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137338321Medicaid