Provider Demographics
NPI:1548558323
Name:GREGORY GULLO, MD PC
Entity Type:Organization
Organization Name:GREGORY GULLO, MD PC
Other - Org Name:INTEGRATED SPINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-512-1212
Mailing Address - Street 1:24076 SE STARK ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3373
Mailing Address - Country:US
Mailing Address - Phone:503-512-1212
Mailing Address - Fax:503-512-1220
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:SUITE 2014
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2455
Practice Address - Country:US
Practice Address - Phone:503-512-1212
Practice Address - Fax:503-512-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty