1326091687 NPI number — DOUGLAS C GULA D.O.

Table of content: DOUGLAS C GULA D.O. (NPI 1326091687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326091687 NPI number — DOUGLAS C GULA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULA
Provider First Name:
DOUGLAS
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1326091687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 NW WASHINGTON BLVD
Provider Second Line Business Mailing Address:
STE. A
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45013-6384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-867-4165
Provider Business Mailing Address Fax Number:
513-867-4168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 NW WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45013-6384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-867-4165
Provider Business Practice Location Address Fax Number:
513-867-4168
Provider Enumeration Date:
05/18/2006

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: 207X00000X , with the licence number:  34003360G , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 02001911A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2725224985-00 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000034778 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200067940A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200028985 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 316675200 . This is a "US DEPT OF LABOR PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6493507500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0646653 . This is a "AETNA PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0900788 . This is a "UNITED HEALTHCARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1514328 . This is a "UNITED MINE WORKERS PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 0539911 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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