| Lance E Bullock, Md, A Professional Medical Corporation | |
|
3136 S Saint Landry Ave Gonzales LA 70737-5801 | |
| (225) 647-7524 | |
| Not Available |
| Full Name | Lance E Bullock, Md, A Professional Medical Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3136 S Saint Landry Ave, Gonzales, Louisiana |
| Authorized Official Name and Position | Sharon F Bullock (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 2256738258 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lance E Bullock, Md, A Professional Medical Corporation 37459 Ultima Plaza Blvd, Suite B, Pmb 227 Prairieville LA 70769-3856 Ph: (225) 673-8258 | Lance E Bullock, Md, A Professional Medical Corporation 3136 S Saint Landry Ave Gonzales LA 70737-5801 Ph: (225) 647-7524 |
| NPI Number | 1265465397 |
|---|---|
| Provider Enumeration Date | 07/09/2006 |
| Last Update Date | 05/21/2009 |
| Medicare PECOS PAC ID | 7810893526 |
|---|---|
| Medicare Enrollment ID | O20031211000734 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265465397 | NPI | - | NPPES |
| 1683728 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 09761R (Louisiana) | Primary |
| Provider Name | Lance E Bullock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225236235 PECOS PAC ID: 4385540194 Enrollment ID: I20031211000657 |
| Provider Name | Maureen P Whitely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386065449 PECOS PAC ID: 1951625961 Enrollment ID: I20150122001866 |
| Provider Name | Carol J Darr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265514426 PECOS PAC ID: 2567894413 Enrollment ID: I20200323000248 |
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