Gary Phillip Bullard, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9104382 Issued in FL

Practice address

4566 E Highway 20 Ste 105
Niceville, FL 32578-8839

Phone

(850) 279-4543

Fax

(850) 279-4827

NPI assigned

Feb 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Healthcare Physicians of Southern Illinois, PC

  • Family Medicine Physician
  • Belleville, IL
  • NPI 1023034618

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609891200000",
    "number": "1831165638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4566 E HIGHWAY 20 STE 105",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788839",
            "telephone_number": "850-279-4543",
            "fax_number": "850-279-4827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4566 E HIGHWAY 20 STE 105",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788839",
            "telephone_number": "850-279-4543",
            "fax_number": "850-279-4827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "GARY",
        "middle_name": "PHILLIP",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-00280",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9104382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Migdalia Browns, PH.D
• Bryan N House DDS PA
• Skylar Bryant
• Daniel Reed Buchan, D.O
• Christine D Buchanan, PT, DPT
• Alexa Mikael Burgeess, COTA/L, CSRS, CNS
• Ross Steven Burks, PT, DPT
• Tracey R Burton-Lindner, MD
• Veronica Butcher
• Eliana Butler

• Medical Physician Assistant in Niceville, FL
• Providers in Niceville, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.