MEDICARE: NATHAN F.E. ULLRICH M.D.

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	174400000X	Specialist	MD00044697	WA
2	208800000X	Urology Physician	MD154094	OR

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	:	1518067339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN F.E. ULLRICH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1520
Second Line	:	1805 E. 19TH ST
City	:	THE DALLES
State	:	OR
Zip	:	97058-8003
Country	:	US
Telephone Number	:	541-296-2201
Fax Number	:	541-296-1237

Provider Business Practice Location Address
First Line	:	1805 E 19TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-3365
Country	:	US
Telephone Number	:	541-296-2201
Fax Number	:	541-296-1237

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/13/2021

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