Provider Demographics
NPI:1790728145
Name:BULLARD, REMUS B III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:REMUS
Middle Name:B
Last Name:BULLARD
Suffix:III
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 1:311 9TH AVENUE DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3829
Mailing Address - Country:US
Mailing Address - Phone:828-322-7338
Mailing Address - Fax:828-304-6319
Practice Address - Street 1:311 9TH AVENUE DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3829
Practice Address - Country:US
Practice Address - Phone:828-322-7338
Practice Address - Fax:828-304-6319
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NC102375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical