Individual
DR. GARY MICHAEL ULLERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
98 POPLAR ST FL 2, BLACKFOOT, ID 83221-1758
(208) 782-2380
(208) 785-3504
Mailing address
98 POPLAR ST FL 2, BLACKFOOT, ID 83221-1758
(208) 782-2380
(208) 785-3504
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
O-0906
ID
208000000X
Pediatrics Physician
O-0906
ID
Other
Enumeration date
06/21/2012
Last updated
01/03/2020
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