Provider Demographics
NPI:1477577542
Name:ULLRICH, JOHN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:ULLRICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2710 HARNEY STREET, SUITE 204
Mailing Address - Street 2:SNOWY RANGE SURGICAL SPECIALTIES
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072
Mailing Address - Country:US
Mailing Address - Phone:307-460-2055
Mailing Address - Fax:307-460-2058
Practice Address - Street 1:2710 HARNEY STREET, SUITE 204
Practice Address - Street 2:SNOWY RANGE SURGICAL SPECIALTIES
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072
Practice Address - Country:US
Practice Address - Phone:307-460-2055
Practice Address - Fax:307-460-2058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY8535A208600000X
CAA83997208600000X
CO48808208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery