Provider Demographics
NPI:1407911803
Name:BULLINGER, ROBERT L SR (PA C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BULLINGER
Suffix:SR
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8170
Mailing Address - Country:US
Mailing Address - Phone:352-622-7222
Mailing Address - Fax:352-622-6591
Practice Address - Street 1:1752 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8170
Practice Address - Country:US
Practice Address - Phone:352-622-7222
Practice Address - Fax:352-622-6591
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAX0000699363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97622Medicare ID - Type UnspecifiedGROUP
S15595Medicare UPIN