Provider Demographics
NPI:1871560722
Name:GULICK, JAMES W (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:GULICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 SW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1496
Mailing Address - Country:US
Mailing Address - Phone:541-760-7016
Mailing Address - Fax:
Practice Address - Street 1:2793 SW 45TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1496
Practice Address - Country:US
Practice Address - Phone:541-760-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10731207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR050008121OtherRR MEDICARE
WA8123887Medicaid
OR076497Medicaid
WA8123887Medicaid
OR076497Medicaid