Provider Demographics
NPI:1578192019
Name:BULMASH, REESE (DO)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:
Last Name:BULMASH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6547
Mailing Address - Country:US
Mailing Address - Phone:770-570-0380
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 689022
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37068-9022
Practice Address - Country:US
Practice Address - Phone:615-465-7000
Practice Address - Fax:615-628-6877
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS29754207PS0010X
MST-4146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200004671Medicaid