Provider Demographics
NPI:1467432666
Name:BULLOCK, JOSEPH D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 RAVINES EDGE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5424
Mailing Address - Country:US
Mailing Address - Phone:614-846-5944
Mailing Address - Fax:614-846-6504
Practice Address - Street 1:8080 RAVINES EDGE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5424
Practice Address - Country:US
Practice Address - Phone:614-846-5944
Practice Address - Fax:614-846-6504
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-0076207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105586Medicaid
OHA80874Medicare UPIN
OHBU0549111Medicare PIN