Individual
MR. JOHN OLIVER ULMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1058
SC
363AS0400X
Surgical Physician Assistant
Primary
1058
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0799PA
—
SC
01
—
218442
MEDCOST
SC
Enumeration date
04/15/2009
Last updated
02/22/2021
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