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General NPI Number Information
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NPI Number | 1710393723
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Entity Type | Individual
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Provider Name | JOSEPH ROBERT GULLERUD PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 1815 SW MARLOW AVE STE 100
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City | PORTLAND
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State | OR
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Zip | 97225-5185
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Country | US
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Telephone | 503-935-8100
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Fax | 503-935-8110
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Provider Business Mailing Address
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Address Line | 541 NE 20TH AVE STE 225
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City | PORTLAND
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State | OR
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Zip | 97232-2895
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Country | US
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Telephone | 503-963-2801
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Fax | 503-963-2825
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA182582
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License Number State | OR
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