NPIMap

Organization Active NPI

Peter Bullock MD PC

  • Family Medicine Physician
  • Mustang, OK
National Provider Identifier
1225359805
Registry record updated Jun 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PETER BULLOCK MD PC
Practice address
206 N Mustang Mall Ter
Mustang, OK 73064-5135
Phone
(405) 256-6000
Fax
(405) 256-6001
NPI assigned
Jun 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peter Bullock, M.D.
Title
Owner
Phone
(405) 256-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

206 N Mustang Mall Ter
Mustang, OK 73064-5135

Mailing address

206 N Mustang Mall Ter
Mustang, OK 73064-5135
Phone (405) 256-6000

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidOK

National Provider Directory

National Provider Directory

Locations

206 N Mustang Mall Ter
Mustang, OK 73064
Phone (405) 256-6000

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1225359805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N MUSTANG MALL TER",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730645135",
            "telephone_number": "405-256-6000",
            "fax_number": "405-256-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N MUSTANG MALL TER",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730645135",
            "telephone_number": "405-256-6000",
            "fax_number": "405-256-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER BULLOCK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-17",
        "last_updated": "2010-06-17",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-256-6000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mustang, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.