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General NPI Number Information
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NPI Number | 1063589026
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Entity Type | Individual
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Provider Name | GEOFFREY M GULLO MD
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 335 SE 8TH AVE
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City | HILLSBORO
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State | OR
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Zip | 97123-4246
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Country | US
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Telephone | 513-681-1109
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Fax | 503-681-1835
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Provider Business Mailing Address
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Address Line | PO BOX 28130
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City | PORTLAND
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State | OR
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Zip | 97228-8130
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Country | US
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Telephone | 503-681-1109
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Fax | 503-681-1835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD24515
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License Number State | OR
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