Provider Demographics
NPI:1467423509
Name:BULLER, ERIC J (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:BULLER
Suffix:
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 1:4809 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE 230
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8800
Mailing Address - Country:US
Mailing Address - Phone:337-235-7898
Mailing Address - Fax:337-235-7445
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 230
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-470-2739
Practice Address - Fax:337-470-6495
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10253363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5R568P206Medicare ID - Type Unspecified
LAS75269Medicare UPIN