Provider Demographics
NPI:1053371104
Name:BULLARD, ROBERT EUGENE JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:BULLARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1437
Mailing Address - Country:US
Mailing Address - Phone:843-332-2605
Mailing Address - Fax:843-857-4406
Practice Address - Street 1:214 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4304
Practice Address - Country:US
Practice Address - Phone:843-333-2260
Practice Address - Fax:843-857-4406
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC119222Medicaid
SCP00906614OtherRAILROAD MEDICARE PTAN
421846Medicare Oscar/Certification
SCB92251Medicare UPIN
SC119222Medicaid