Provider Demographics
NPI:1346320157
Name:KULUS, JOHN J (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:KULUS
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 1:1220 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-1839
Mailing Address - Country:US
Mailing Address - Phone:503-838-3665
Mailing Address - Fax:503-838-3663
Practice Address - Street 1:1220 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-1839
Practice Address - Country:US
Practice Address - Phone:503-838-3665
Practice Address - Fax:503-838-3663
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO-09565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR102129Medicaid
OR102129Medicaid
OR000LGBFBMedicare ID - Type UnspecifiedMEDICARE