Individual
BRIAN ULLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 W 1ST ST, WAPATO, WA 98951-1108
(509) 877-4111
(509) 877-7349
Mailing address
620 W 1ST ST, WAPATO, WA 98951-1108
(509) 877-4111
(509) 877-7349
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00032635
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6730
GROUP HEALTH
—
01
—
8180184
CHPW
WA
05
—
8180184
—
WA
01
—
911019392
COMMERCIAL
—
01
—
UL4310
REGENCE
WA
Enumeration date
10/05/2006
Last updated
03/24/2021
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