Provider Demographics
NPI:1427196807
Name:WILLIAM J BULKLEY M D P A
Entity Type:Organization
Organization Name:WILLIAM J BULKLEY M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JENNISON
Authorized Official - Last Name:BULKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-240-8020
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72451-0579
Mailing Address - Country:US
Mailing Address - Phone:870-240-8020
Mailing Address - Fax:870-240-8028
Practice Address - Street 1:1000 W KINGSHIGHWAY
Practice Address - Street 2:STE # 3
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4141
Practice Address - Country:US
Practice Address - Phone:870-240-8020
Practice Address - Fax:870-240-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207KA0200X, 207Y00000X, 207YS0012X, 207YX0602X, 207YX0905X, 2082S0099X, 208600000X, 2086S0122X
ARA417231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131753002Medicaid
AR5G505Medicare PIN