MEDICARE: JEFFREY GULLER 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	2085R0204X	Vascular & Interventional Radiology Physician	1330	VI

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	:	1356341705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GULLER MD

Provider Business Mailing Address
First Line	:	PO BOX 11839
Second Line	:
City	:	ST THOMAS
State	:	VI
Zip	:	00801-4839
Country	:	US
Telephone Number	:	340-774-0265
Fax Number	:	340-776-0228

Provider Business Practice Location Address
First Line	:	9149 ESTATE THOMAS
Second Line	:	PARAGON MEDICAL BLDG, STE 103
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2615
Country	:	US
Telephone Number	:	340-774-0265
Fax Number	:	340-776-0228

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/03/2007

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Directions to “ JEFFREY GULLER MD” Practice Location

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