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Contact Information

SAMUEL W BULLICK, DO
1015 NW 22ND AVE
PORTLAND, OR97210-3025
 Phone: 503-413-8407
 Fax: 503-413-6951
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for SAMUEL W BULLICK · (Male)

NPI # 1386904662
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 05/21/2012
Last updated 09/05/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • OR License # DO188659
  • OR License # LL158520
Hospital affiliation(s)
  • LEGACY EMANUEL MEDICAL CENTER - (Acute Care)
    2801 N GANTENBEIN AVENUE
    PORTLAND, OR 97227
  • LEGACY GOOD SAMARITAN MEDICAL CENTER - (Acute Care)
    1015 NW 22ND AVENUE, W121
    PORTLAND, OR 97210
  • LEGACY MERIDIAN PARK MEDICAL CENTER - (Acute Care)
    19300 SW 65TH AVENUE
    TUALATIN, OR 97062
  • LEGACY MOUNT HOOD MEDICAL CENTER - (Acute Care)
    24800 SE STARK STREET
    GRESHAM, OR 97030
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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