Provider Demographics
NPI:1851374565
Name:BULLEN, THOMAS ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDREW
Last Name:BULLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:113 TREFTON CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6559
Mailing Address - Country:US
Mailing Address - Phone:916-983-5169
Mailing Address - Fax:916-734-7710
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:SUITE 4100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-5846
Practice Address - Fax:916-734-7710
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG60550208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G605500Medicaid
CA00G605500Medicaid