Individual
DR. DONALD ALBERT GULLICKSON
Active
Individual
DR. DONALD ALBERT GULLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2072A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102799900
—
WY
01
—
110055880
MEDICARE RAILROAD RETIREM
—
01
—
301810
BLUE SHIELD
WY
Enumeration date
10/04/2006
Last updated
01/31/2020
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