Provider Demographics
NPI:1841435757
Name:BULLOCK, RICHARD ALAN JR
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:BULLOCK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST STE 102E
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2477
Mailing Address - Country:US
Mailing Address - Phone:570-476-1000
Mailing Address - Fax:570-476-1035
Practice Address - Street 1:411 MAIN ST STE 102E
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2477
Practice Address - Country:US
Practice Address - Phone:570-476-1000
Practice Address - Fax:570-476-1035
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03342237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist