Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | BP10047662 | TX |
Y | 207T00000X | Neurosurgeon | DR.0058235 | CO |
NPI | 1578907671 |
---|---|
Provider Name | Dr. Thomas J Bullock |
First Address | Aurora, CO 80014-1618 |
Second Address | Denver, CO 80205-5422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2013 |
Last Update Date | 26/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028905 | KAISER COMMERCIAL NUMBER (01) | CO |
9000149868 | (05) | CO |