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Mr. John C. Gullage, PA-C
Surgical Physician Assistant in Lebanon, Missouri
NPI 1558399923

John C. Gullage is a Surgical Physician Assistant based in Lebanon, MO and is specialized in Surgical. John C. Gullage practices in Lebanon, MO and has the professional credentials of PA-C. The NPI Number for John C. Gullage is 1558399923 and holds a License No. PA10002052 (Missouri).

The current practice location address for John C. Gullage is 331 Hospital Dr Ste A, Lebanon, MO and can be reached out via phone at 417-533-6560.

Location: 331 Hospital Dr Ste A, Lebanon, MO, 65536-9251
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1558399923
Provider Name
John C. Gullage
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
331 Hospital Dr Ste A, Lebanon, MO, 65536-9251
Phone Number
417-533-6560
Fax Number
Provider Enumeration Date
06/28/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
132300404 01 MO MEDICARE
institution
Provider Business Practice Location Address Details
Address
331 Hospital Dr Ste A
City
Lebanon
State
Missouri
Zip
65536-9251
Phone Number
417-533-6560
Fax Number
person
Provider Business Mailing Address Details
Address
331 Hospital Dr Ste A
City
Lebanon
State
Missouri
Zip
65536-9251
Phone Number
417-533-6560
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
363AS0400X
License No.
PA10002052 (Washington)
Definition
Definition to come...
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