Provider Demographics
NPI:1013938927
Name:BULLIS, DAVID WRISLEY (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WRISLEY
Last Name:BULLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1151 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5565
Practice Address - Country:US
Practice Address - Phone:508-973-2211
Practice Address - Fax:508-973-9885
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78896207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3125041Medicaid
MA3125041Medicaid
MAJ14614Medicare ID - Type Unspecified
F55590Medicare UPIN