Provider Demographics
NPI:1326091687
Name:GULA, DOUGLAS C (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:GULA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 NW WASHINGTON BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6384
Mailing Address - Country:US
Mailing Address - Phone:513-867-4165
Mailing Address - Fax:513-867-4168
Practice Address - Street 1:840 NW WASHINGTON BLVD
Practice Address - Street 2:STE. A
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6384
Practice Address - Country:US
Practice Address - Phone:513-867-4165
Practice Address - Fax:513-867-4168
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003360G207X00000X
IN02001911A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2725224985-00OtherWORKERS COMPENSATION
OH000000034778OtherANTHEM PIN
IN200067940AMedicaid
OH200028985OtherRR MEDICARE
OH316675200OtherUS DEPT OF LABOR PIN
KY6493507500Medicaid
OH0646653OtherAETNA PIN
OH0900788OtherUNITED HEALTHCARE PIN
OK1514328OtherUNITED MINE WORKERS PIN
OH0539911Medicaid
KY6493507500Medicaid
OH2725224985-00OtherWORKERS COMPENSATION
OH0758375Medicare PIN