Provider Demographics
NPI:1548590557
Name:BULLOCKS PLASTIC SURGERY, P.L.L.C.
Entity type:Organization
Organization Name:BULLOCKS PLASTIC SURGERY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-218-9100
Mailing Address - Street 1:2600 WEST HOLCOMBE BLVD
Mailing Address - Street 2:SUITE 179
Mailing Address - City:HOUSTON
Mailing Address - State:TEXAS
Mailing Address - Zip Code:77030
Mailing Address - Country:UM
Mailing Address - Phone:713-218-9100
Mailing Address - Fax:713-665-8873
Practice Address - Street 1:9122 KAPRI LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-4202
Practice Address - Country:US
Practice Address - Phone:713-218-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5077208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty