Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 110242 | MO |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | E1362 | AR |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | K6995 | TX |
NPI | 1386638286 |
---|---|
Provider Name | Mr. William Jennison Bulkley |
First Address | Paragould, AR 72451-0579 |
Second Address | Paragould, AR 72450-4141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 09/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131703001 | (05) | AR |
G48075 | (02) |