Provider Demographics
NPI:1386641223
Name:BULLER, JIMMY V (DO)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:V
Last Name:BULLER
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 1:1509 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-3332
Mailing Address - Country:US
Mailing Address - Phone:620-423-3307
Mailing Address - Fax:620-423-3329
Practice Address - Street 1:1509 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-3332
Practice Address - Country:US
Practice Address - Phone:620-423-3307
Practice Address - Fax:620-423-3329
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0517965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098500EMedicaid
KS9795OtherBCBS
KS100098500BMedicaid
KSE43232Medicare UPIN
KS100098500EMedicaid
KS080042951Medicare PIN
KS9795OtherBCBS