Provider Demographics
NPI:1407849151
Name:BULEN, SUSAN RUTH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RUTH
Last Name:BULEN
Suffix:
Gender:F
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 36179
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6179
Mailing Address - Country:US
Mailing Address - Phone:520-296-9399
Mailing Address - Fax:520-296-9551
Practice Address - Street 1:1921 W HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7806
Practice Address - Country:US
Practice Address - Phone:520-296-9399
Practice Address - Fax:520-296-9551
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20625208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20625Medicare ID - Type Unspecified
F30108Medicare UPIN