Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME75847 | FL |
NPI | 1043207293 |
---|---|
Provider Name | Dr. Sherrie Lenise Bullard |
First Address | Pembroke Pines, FL 33084-0098 |
Second Address | Weston, FL 33331-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G56236 | (02) | FL |