Individual
MR. JOHN C. GULLAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
331 HOSPITAL DR STE A, LEBANON, MO 65536-9251
(417) 533-6560
Mailing address
331 HOSPITAL DR STE A, LEBANON, MO 65536-9251
(417) 533-6560
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
1999
NE
363AS0400X
Surgical Physician Assistant
Primary
2013029322
MO
363AS0400X
Surgical Physician Assistant
PA10002052
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132300404
MEDICARE
MO
Enumeration date
06/28/2006
Last updated
03/17/2021
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