Provider Demographics
NPI:1932159886
Name:ULLOTH, JOEL ELDEN (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ELDEN
Last Name:ULLOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-229-3703
Practice Address - Street 1:85 MAUI LANI PKWY
Practice Address - Street 2:
Practice Address - City:MAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96001-2414
Practice Address - Country:US
Practice Address - Phone:808-442-5700
Practice Address - Fax:808-442-5701
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2019-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA108943208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery