Individual
DR. DONALD ALBERT GULLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
745 BUENA VISTA DR, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-2068
Mailing address
830 LINCOLN ST, LANDER, WY 82520-2736
(307) 332-4420
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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