Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 78896 | MA |
NPI | 1013938927 |
---|---|
Provider Name | Mr. David Wrisley Bullis |
First Address | Fairhaven, MA 02719-5255 |
Second Address | Fall River, MA 02720-5565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 01/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3125041 | (05) | MA |
F55590 | (02) |