Provider Demographics
NPI:1841504875
Name:YVONNE BULLARD MD PA
Entity type:Organization
Organization Name:YVONNE BULLARD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-2229
Mailing Address - Street 1:801 E 6TH ST STE 606
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3645
Mailing Address - Country:US
Mailing Address - Phone:850-785-2229
Mailing Address - Fax:850-785-1806
Practice Address - Street 1:801 E 6TH ST STE 606
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3645
Practice Address - Country:US
Practice Address - Phone:850-785-2229
Practice Address - Fax:850-785-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053167207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL077932680Medicaid
FL07385Medicare PIN
FL077932680Medicaid