1053163402 NPI number — DR. GARY LAWRENCE ULRICH JR. MD

Table of content: DR. GARY LAWRENCE ULRICH JR. MD (NPI 1053163402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053163402 NPI number — DR. GARY LAWRENCE ULRICH JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULRICH
Provider First Name:
GARY
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053163402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 ALLENDALE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47802-4751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-229-9003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
P.O. BOX 68-30705
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPSOWAR
Provider Business Practice Location Address State Name:
ELGEYO MARAKWET COUNTY
Provider Business Practice Location Address Postal Code:
30705
Provider Business Practice Location Address Country Code:
KE
Provider Business Practice Location Address Telephone Number:
79-841-6877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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