Forrest A Bullock, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

7575794-1205 Issued in UT

Practice address

5268 W Bowstring Way
South Jordan, UT 84009-6161

Phone

(307) 760-3869

NPI assigned

Dec 9, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Inland Empire Hospital Services Association

  • Family Medicine Physician
  • Spokane, WA
  • NPI 1326002163
  NPD (past)

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544745600000",
    "number": "1497730642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5268 W BOWSTRING WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096161",
            "telephone_number": "307-760-3869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5268 W BOWSTRING WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096161",
            "telephone_number": "307-760-3869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "FORREST",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2018-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "7575794-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8352718",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell Brown, PHARMD
• Tanner Browning, NP
• Lilia P Buchmuller, DNP, FNP-C
• Megan Buckley
• Alyssa Katherine Buist, RBT
• Jerel Bullock, R.PH.
• Adam Bullough
• Derek Burgoyne, DMD
• Adam Ross Bushell, D.D.S.
• Butterfly Effects

• Internal Medicine Physician in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Internal Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; 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.