Individual
JOSEPH ROBERT GULLERUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1815 SW MARLOW AVE STE 100, PORTLAND, OR 97225-5185
(503) 935-8100
(503) 935-8110
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA182582
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2078286
—
WA
05
—
500724113
—
OR
Enumeration date
07/10/2014
Last updated
10/30/2025
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