Healthcare Provider Details

I. General information

NPI: 1871560722
Provider Name (Legal Business Name): JAMES W. GULICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 SW 45TH ST
CORVALLIS OR
97333-1496
US

IV. Provider business mailing address

2793 SW 45TH ST
CORVALLIS OR
97333-1496
US

V. Phone/Fax

Practice location:
  • Phone: 541-760-7016
  • Fax:
Mailing address:
  • Phone: 541-760-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD10731
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: