Individual
GEORGE JACKSON ULLRICH
Active
Individual
GEORGE JACKSON ULLRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M6400
ID
2084P0800X
Psychiatry Physician
MD00031416
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000418
BLUE CROSS BLUE SHIELD
—
01
—
22698
MONTANA MEDICAID
MT
01
—
33852
BLUE CROSS OF IDAHO
ID
Enumeration date
10/03/2006
Last updated
07/08/2007
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