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General NPI Number Information
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NPI Number | 1518067339
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Entity Type | Individual
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Provider Name | NATHAN F.E. ULLRICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 1805 E 19TH ST
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City | THE DALLES
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State | OR
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Zip | 97058-3365
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Country | US
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Telephone | 541-296-2201
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Fax | 541-296-1237
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Provider Business Mailing Address
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Address Line | PO BOX 1520 1805 E. 19TH ST
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City | THE DALLES
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State | OR
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Zip | 97058-8003
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Country | US
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Telephone | 541-296-2201
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Fax | 541-296-1237
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00044697
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD154094
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License Number State | OR
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