Provider Demographics
NPI:1982658126
Name:GULLICKSON, GAIL (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:GULLICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 MIRANDA AVE
Mailing Address - Street 2:MAILCODE 182B
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1207
Mailing Address - Country:US
Mailing Address - Phone:650-943-5000
Mailing Address - Fax:650-496-2025
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:MAILCODE 182B
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-943-5000
Practice Address - Fax:650-496-2025
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46359207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine