Provider Demographics
NPI:1043473226
Name:GULLETT, JOHN WATHAN II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WATHAN
Last Name:GULLETT
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:5535 FAIR LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3434
Mailing Address - Country:US
Mailing Address - Phone:513-221-5274
Mailing Address - Fax:513-961-5100
Practice Address - Street 1:563 WESSEL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3668
Practice Address - Country:US
Practice Address - Phone:513-858-6500
Practice Address - Fax:513-858-2777
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2013-12-31
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Provider Licenses
StateLicense IDTaxonomies
OH097924207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH097924OtherOHIO LECENSE NUMBER