Basic Information
| Provider Information | |||||||||
| NPI: | 1467423509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULLER | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4809 AMBASSADOR CAFFERY PKWY | ||||||||
| Address2: | STE 230 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705088800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372357898 | ||||||||
| FaxNumber: | 3372357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 4809 AMBASSADOR CAFFERY PKWY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705088800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372357898 | ||||||||
| FaxNumber: | 3372357445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | A10253 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.