Mr. Gary W. Watulak M.S.
Full Name
Mr. Gary Wayne Watulak M.S.
NPI Number
1952312373
NPI Type
Individual Provider
Gender
Male
Enumeration Date
08/10/2006
Specialties
(Taxonomies)Name
Code
103TC0700X
103TB0200X
103TC1900X
103TF0000X
103TP2701X
103T00000X
Primary Taxonomy
No
No
No
No
No
No
Licenses
State
Vermont
License Number
0470000240
Contact
Information
Purpose
Mailing
Location
Address
26 COTTAGE ST
26 COTTAGE ST
City
Rutland
Rutland
State
VT
VT
Postal Code
05701-3404
05701-3404
Country
US
US
Telephone Number
(802) 775-6031
(802) 775-6031
Identifiers
Identifier
51742
0006590
331856
11326073
691411
6590
Identifier State
Unknown
VT
VT
Unknown
VT
VT
Identifier Issuer
CIGNA
Unknown
MHN
CAQH
MVP
BCBS
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 07/08/2007