Provider Demographics
NPI:1922056944
Name:BULLARD, YVONNE D (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:D
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E 6TH ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3661
Mailing Address - Country:US
Mailing Address - Phone:850-785-2229
Mailing Address - Fax:850-785-1806
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 606
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3661
Practice Address - Country:US
Practice Address - Phone:850-785-2229
Practice Address - Fax:850-785-1806
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053167207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21443Medicare UPIN
FL07385Medicare ID - Type Unspecified