Provider Demographics
NPI:1265790612
Name:GULLEY, CHRISTOPHER O (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:O
Last Name:GULLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:STE 400
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-677-2000
Mailing Address - Fax:806-356-0045
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:400
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-677-2000
Practice Address - Fax:806-356-0045
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ4121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88674703Medicaid
OK200622020 AMedicaid
TX353267301Medicaid
TX353267302Medicaid
NM88674703Medicaid