Provider Demographics
NPI:1356784532
Name:BULLOCK, VALERIE JANE (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:JANE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:JANE
Other - Last Name:EBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6400 E GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2268
Mailing Address - Country:US
Mailing Address - Phone:513-791-5521
Mailing Address - Fax:513-342-5395
Practice Address - Street 1:6400 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2268
Practice Address - Country:US
Practice Address - Phone:513-791-5521
Practice Address - Fax:513-342-5395
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.149358207Q00000X
CAA132130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine