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Dana Jill Bullock

Family Medicine

Allopathic & Osteopathic Physicians

1500 S Main St, Fort Worth, TX 76104-4917

PECOS Enrollment

This provider is enrolled in PECOS as DANA BULLOCK.

Based on the most recent information from CMS, provider Dana Jill Bullock is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1114422078
Provider Type
Individual
Full Name
Bullock, Dana Jill
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
3/23/2018
Last Updated
6/23/2023

Contact Information

Practice Location

1500 S Main St, Fort Worth, TX 76104-4917

(817) 702-1173

Unlisted Fax

Mailing Location

1500 S Main St, Fort Worth, TX 76104-4917

(817) 702-1173

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License S3952 Texas
Code 225100000X	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 1143501 Texas

Dana Jill Bullock

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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