Provider Demographics
NPI:1952383929
Name:BULLOCK, DANIEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:444 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3450
Mailing Address - Country:US
Mailing Address - Phone:530-842-1267
Mailing Address - Fax:530-926-6435
Practice Address - Street 1:475 BRUCE STREET
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3450
Practice Address - Country:US
Practice Address - Phone:530-842-1267
Practice Address - Fax:530-842-9121
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30957207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30957OtherSTATE LICENSE NUMBER
FS451ZOtherPTAN