Provider Demographics
NPI:1225068984
Name:ULMER, DOUGLAS KENT (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KENT
Last Name:ULMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:819
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813
Mailing Address - Country:US
Mailing Address - Phone:562-435-5621
Mailing Address - Fax:562-437-3121
Practice Address - Street 1:1045 ATLANTIC AVE STE 819
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3410
Practice Address - Country:US
Practice Address - Phone:562-435-5621
Practice Address - Fax:562-437-3121
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24825207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248250Medicaid
CAA24149Medicare UPIN
CAWA24825AMedicare PIN