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General NPI Number Information
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NPI Number | 1770511669
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Entity Type | Individual
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Provider Name | THOMAS ANDREW GULICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 312 GRAMMONT STREET; SUITE 402
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-966-6550
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Fax | 318-966-6551
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Provider Business Mailing Address
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Address Line | 312 GRAMMONT STREET; SUITE 402
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-966-6550
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Fax | 318-966-6551
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 014119
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License Number State | LA
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