Provider Demographics
NPI:1356327266
Name:BULLMASTER, JOHN
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BULLMASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:160 WYOMING ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2740
Practice Address - Country:US
Practice Address - Phone:937-228-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046302208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery