# MR. JOHN C. GULLAGE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1558399923
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 1999 | NE | — |
| 363AS0400X | Surgical Physician Assistant | 2013029322 | MO | Yes |
| 363AS0400X | Surgical Physician Assistant | PA10002052 | WA | — |

## Other

- **Enumeration date:** 06/28/2006
- **Last updated:** 03/17/2021