Provider Demographics
NPI:1073748158
Name:GULLETT, JAMES JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JEROME
Last Name:GULLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:818 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2263
Mailing Address - Country:US
Mailing Address - Phone:606-776-7946
Mailing Address - Fax:
Practice Address - Street 1:103 S BRADFORD LN
Practice Address - Street 2:#102
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2336
Practice Address - Country:US
Practice Address - Phone:502-863-3112
Practice Address - Fax:502-863-3113
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology