William Ralph Gulledge Jr., M.D.
Individual provider Active NPI Neurology Physician · Springdale, UT
NPI 1164418364 · NPPES record last updated Jul 14, 2015
Key facts
- NPI
- 1164418364
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- E9213 (TX)
- Practice address
- 2548 Anasazi Way
Springdale, UT 84767 - Phone
- (817) 921-4191
- Fax
- (866) 221-1446
- NPI assigned
- Sep 22, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100503000172 | TX | Practitioner - Neurology | 6901970557 | Practice locations: Ft Worth, TX |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E9213 | TX | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neural Watch LLC | Past | Accepting new patients | |
| Clinical Neuroscience PA | Neurology | Past | Accepting new patients |
Interoperability endpoints
- wgulledge@direct.uspi.com
- https://api.platform.athenahealth.com/9382/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | E9213 | TX | Yes |
Addresses
Primary practice location
2548 Anasazi Way
Springdale, UT 84767
Mailing address
PO Box 247
Springdale, UT 84767-0247
Phone (817) 929-1815
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PO84931FG | Medicaid | TX |
Other providers in Springdale, UT
- Daily Habits Nutrition LLC
- Adam Hyatt
- Helen G McMahan
- Michael G McMahan
- National Park Service
- Resort Medical Services, P.C.
All providers in Springdale, UT · Neurology Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.