Provider Demographics
NPI:1679544688
Name:ULLRICH, CHRIS ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:ROBERT
Last Name:ULLRICH
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Gender:M
Credentials:DO
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Mailing Address - Street 1:12990 MANCHESTER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1860
Mailing Address - Country:US
Mailing Address - Phone:636-239-1650
Mailing Address - Fax:636-239-9005
Practice Address - Street 1:1351 JEFFERSON ST
Practice Address - Street 2:STE 110
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-6449
Practice Address - Country:US
Practice Address - Phone:636-239-1650
Practice Address - Fax:636-239-9005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2020-11-24
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Provider Licenses
StateLicense IDTaxonomies
MO2000158832207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245411418Medicaid