Individual
GEORGE JACKSON ULLRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 IRONWOOD DRIVE, COEUR D ALENE, ID 83814
(208) 765-0955
(208) 765-6972
Mailing address
PO BOX 1356, COEUR D ALENE, ID 83816
(208) 765-0955
(208) 765-6972
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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