Provider Demographics
NPI:1891717096
Name:BULLARD, TY LORAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:LORAN
Last Name:BULLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2201 UNC HOSPITALS
Mailing Address - Street 2:CB #7010
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7010
Mailing Address - Country:US
Mailing Address - Phone:919-966-5136
Mailing Address - Fax:919-966-4873
Practice Address - Street 1:N2201 UNC HOSPITALS
Practice Address - Street 2:CB #7010
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7010
Practice Address - Country:US
Practice Address - Phone:919-966-5136
Practice Address - Fax:919-966-4873
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9118174400000X
NC2007-00270207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist