Provider Demographics
NPI:1568467876
Name:BULL, ROBERT L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:BULL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5320 MILITARY RD
Mailing Address - Street 2:STE 106
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-298-5433
Mailing Address - Fax:716-298-5434
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:STE 106
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-298-5433
Practice Address - Fax:716-298-5434
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-11-14
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Provider Licenses
StateLicense IDTaxonomies
NY158870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00841350Medicaid
NY003821Medicare ID - Type Unspecified
NYRA0564Medicare PIN
B35586Medicare UPIN