Provider Demographics
NPI:1366594525
Name:GULLETT, BRIAN CHRISTOPHER (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:GULLETT
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 1:343 ADAMIK RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15322-7395
Mailing Address - Country:US
Mailing Address - Phone:724-413-9923
Mailing Address - Fax:
Practice Address - Street 1:343 ADAMIK RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15322-7395
Practice Address - Country:US
Practice Address - Phone:724-413-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2218208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice