Provider Demographics
NPI:1780886515
Name:BULLARD, ELIZABETH SOFIA (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SOFIA
Last Name:BULLARD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2511 OLD CORNWALLIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1869
Mailing Address - Country:US
Mailing Address - Phone:919-932-5700
Mailing Address - Fax:919-933-6881
Practice Address - Street 1:2511 OLD CORNWALLIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1869
Practice Address - Country:US
Practice Address - Phone:919-932-5700
Practice Address - Fax:919-933-6881
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2013-09-18
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Provider Licenses
StateLicense IDTaxonomies
NC2007-001782084P0800X
TXM25742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907021Medicaid
NC2068697Medicare PIN