Provider Demographics
NPI:1497816052
Name:BULLION, CLYDE A (PAC)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:A
Last Name:BULLION
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 DEBARR RD STE 280
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2977
Mailing Address - Country:US
Mailing Address - Phone:907-222-1401
Mailing Address - Fax:907-222-1402
Practice Address - Street 1:2751 DEBARR RD STE 280
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2977
Practice Address - Country:US
Practice Address - Phone:907-222-1401
Practice Address - Fax:907-222-1402
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1033128335OtherGROUP NPI
AKK151946Medicare ID - Type UnspecifiedAK MEDICARE
AKR86112Medicare UPIN