Provider Demographics
NPI:1851561005
Name:WILLIAM A BULLEY MDPS
Entity Type:Organization
Organization Name:WILLIAM A BULLEY MDPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BULLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:253-841-2929
Mailing Address - Street 1:324 E PIONEER
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3264
Mailing Address - Country:US
Mailing Address - Phone:253-841-2929
Mailing Address - Fax:253-840-4931
Practice Address - Street 1:324 E PIONEER
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3264
Practice Address - Country:US
Practice Address - Phone:253-841-2929
Practice Address - Fax:253-840-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1938000Medicaid
WA1938000Medicaid
WA0001000157Medicare NSC