Bullard, Timothy C

Bullard, Timothy C is an sole proprietor health care provider with primary practice located at 4560 Admiralty Way Ste 100 , Marina Del Rey CA 90292-5424. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Bullard, Timothy C can be contacted via phone (108) 273-7003.

Contact Information

Primary practice address
4560 Admiralty Way Ste 100 Marina Del Rey CA 90292-5424
Phone: (108) 273-7003
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X A64738 California
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 01051619 Indiana
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 4301082809 Michigan
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X A64738 California

Profile Details

NPI number 1306801766
LBN Legal business name Bullard, Timothy C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 19th, 2006
Last updated Oct 7th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306801766 NPPES
California MEDICAID 00A647380
California Other 1306801766
California MEDICAID 1306801766
California Other 930098046

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