1265790612 NPI number — CHRISTOPHER O GULLEY M.D.

Table of content: CHRISTOPHER O GULLEY M.D. (NPI 1265790612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265790612 NPI number — CHRISTOPHER O GULLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULLEY
Provider First Name:
CHRISTOPHER
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1265790612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 S COULTER ST
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106-1758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-677-2000
Provider Business Mailing Address Fax Number:
806-356-0045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 S COULTER ST
Provider Second Line Business Practice Location Address:
400
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-677-2000
Provider Business Practice Location Address Fax Number:
806-356-0045
Provider Enumeration Date:
04/23/2012

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: "N" .
  • Taxonomy code: 207R00000X , with the licence number: Q4121 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 88674703 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200622020 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 353267301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 353267302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com