Provider Demographics
NPI:1801975966
Name:GULSRUD, PAUL OLAF (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:OLAF
Last Name:GULSRUD
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 1:23101 SHERMAN PLACE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-712-9154
Mailing Address - Fax:818-712-9187
Practice Address - Street 1:23101 SHERMAN PLACE
Practice Address - Street 2:SUITE 217
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-712-9154
Practice Address - Fax:818-712-9187
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG27226207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G272260Medicaid
A43280Medicare UPIN
CA00G272260Medicaid