MEDICARE: DOUGLAS KENT ULMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A24825	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225068984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS KENT ULMER MD

Provider Business Mailing Address
First Line	:	1045 ATLANTIC AVE
Second Line	:	819
City	:	LONG BEACH
State	:	CA
Zip	:	90813
Country	:	US
Telephone Number	:	562-435-5621
Fax Number	:	562-437-3121

Provider Business Practice Location Address
First Line	:	1045 ATLANTIC AVE STE 819
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3410
Country	:	US
Telephone Number	:	562-435-5621
Fax Number	:	562-437-3121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/11/2018

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Directions to “ DOUGLAS KENT ULMER MD” Practice Location

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