Provider Demographics
NPI:1659452209
Name:ULRICH, NOLAN D (DO)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:D
Last Name:ULRICH
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 1:25 ROUNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-5893
Mailing Address - Country:US
Mailing Address - Phone:256-447-9045
Mailing Address - Fax:256-447-9040
Practice Address - Street 1:25 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-5893
Practice Address - Country:US
Practice Address - Phone:256-447-9045
Practice Address - Fax:256-447-9040
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7929207Q00000X
ALDO 893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100893Medicaid