Basic Information
| Provider Information | |||||||||
| NPI: | 1326091687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GULA | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 NW WASHINGTON BLVD | ||||||||
| Address2: | STE. A | ||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450136384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138674165 | ||||||||
| FaxNumber: | 5138674168 | ||||||||
| Practice Location | |||||||||
| Address1: | 840 NW WASHINGTON BLVD | ||||||||
| Address2: | STE. A | ||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450136384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138674165 | ||||||||
| FaxNumber: | 5138674168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 34003360G | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 02001911A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2725224985-00 | 01 | OH | WORKERS COMPENSATION | OTHER | 000000034778 | 01 | OH | ANTHEM PIN | OTHER | 200067940A | 05 | IN | MEDICAID | 200028985 | 01 | OH | RR MEDICARE | OTHER | 316675200 | 01 | OH | US DEPT OF LABOR PIN | OTHER | 6493507500 | 05 | KY | MEDICAID | 0646653 | 01 | OH | AETNA PIN | OTHER | 0900788 | 01 | OH | UNITED HEALTHCARE PIN | OTHER | 1514328 | 01 | OK | UNITED MINE WORKERS PIN | OTHER | 0539911 | 05 | OH | MEDICAID |