Basic Information
| Provider Information | |||||||||
| NPI: | 1407849151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULEN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36179 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857406179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202969399 | ||||||||
| FaxNumber: | 5202969551 | ||||||||
| Practice Location | |||||||||
| Address1: | 1921 W HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857047806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202969399 | ||||||||
| FaxNumber: | 5202969551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 20625 | AZ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.