Provider Demographics
NPI:1700045622
Name:BULLOCK, RONALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:BULLOCK
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 1:19 SHELTER COVE LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3520
Mailing Address - Country:US
Mailing Address - Phone:843-842-6402
Mailing Address - Fax:843-842-3447
Practice Address - Street 1:19 SHELTER COVE LN
Practice Address - Street 2:SUITE 301
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3520
Practice Address - Country:US
Practice Address - Phone:843-842-6402
Practice Address - Fax:843-842-3447
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11319261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health