Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1305 | AR |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A004917 | AR |
NPI | 1003877739 |
---|---|
Provider Name | Dr. Roger R Bullington |
First Address | Fort Smith, AR 72903 |
Second Address | Fort Smith, AR 72903-3047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 10/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59952 | PROVIDER # (01) | AR |