Provider Demographics
NPI:1366894529
Name:GULLORD, DAHMON KEITH
Entity type:Individual
Prefix:MR
First Name:DAHMON
Middle Name:KEITH
Last Name:GULLORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4142
Mailing Address - Country:US
Mailing Address - Phone:507-848-3748
Mailing Address - Fax:
Practice Address - Street 1:422 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4142
Practice Address - Country:US
Practice Address - Phone:507-848-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNUS DOT 2573346344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi