Provider Demographics
NPI:1568471100
Name:ULRICH, GEORGE GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GREGORY
Last Name:ULRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2770 N UNION BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1193
Mailing Address - Country:US
Mailing Address - Phone:719-471-2020
Mailing Address - Fax:719-633-7379
Practice Address - Street 1:1625 MEDICAL CENTER POINT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-635-5148
Practice Address - Fax:719-667-4219
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0032384207W00000X
CAG60381207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35822864Medicaid
CA00G603810Medicaid
COF92378Medicare UPIN
COCOA102329Medicare PIN