1356341705 NPI number — JEFFREY GULLER MD

Table of content: JEFFREY GULLER MD (NPI 1356341705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356341705 NPI number — JEFFREY GULLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULLER
Provider First Name:
JEFFREY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1356341705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9149 ESTATE THOMAS
Provider Second Line Business Practice Location Address:
PARAGON MEDICAL BLDG, STE 103
Provider Business Practice Location Address City Name:
ST THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-774-0265
Provider Business Practice Location Address Fax Number:
340-776-0228
Provider Enumeration Date:
07/28/2005

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: 2085R0204X , with the licence number:  1330 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01086566 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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