Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000E29390 | CA |
NPI | 1316053127 |
---|---|
Provider Name | Bruce Michael Bulkin |
First Address | Burlingame, CA 94010-3228 |
Second Address | Burlingame, CA 94010-3228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 31/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E29390 | (02) | CA |