Provider Demographics
NPI:1598748097
Name:BULLOCK, DELIA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DELIA
Middle Name:ELIZABETH
Last Name:BULLOCK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:903 WEST MARTIN
Mailing Address - Street 2:MS 19-2
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3110
Mailing Address - Country:US
Mailing Address - Phone:210-358-3710
Mailing Address - Fax:210-358-5941
Practice Address - Street 1:903 WEST MARTIN
Practice Address - Street 2:MS 19-2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3110
Practice Address - Country:US
Practice Address - Phone:210-358-3710
Practice Address - Fax:210-358-5941
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-11-03
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Provider Licenses
StateLicense IDTaxonomies
TXJ4013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG08044Medicare UPIN