Individual
DR. JAIRO ULLOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(504) 289-5522
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2515
(504) 289-5522
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
22872
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1883239
MEDICAID PROVIDER NUMBER
LA
Enumeration date
03/30/2009
Last updated
09/03/2014
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