Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | JU063597 | MI |
NPI | 1043313919 |
---|---|
Provider Name | Dr. James Martin Ulery JR. |
First Address | Monroe, MI 48162-4393 |
Second Address | Monroe, MI 48162-4393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 01/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070E81188-0 | BCBSM NEW GROUP (01) | MI |
0E81006 | BCBS MI (01) | MI |
CL2256 | GROUP RAILROAD MEDICARE (01) | MI |
G39845 | (02) | MI |