Provider Demographics
NPI:1003034208
Name:JULIE GRAVES MOY MD MPH PA
Entity Type:Organization
Organization Name:JULIE GRAVES MOY MD MPH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:GRAVES
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-689-8001
Mailing Address - Street 1:8127 MESA DR
Mailing Address - Street 2:B206-54
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8632
Mailing Address - Country:US
Mailing Address - Phone:512-689-8001
Mailing Address - Fax:
Practice Address - Street 1:8127 MESA DR
Practice Address - Street 2:B206-54
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8632
Practice Address - Country:US
Practice Address - Phone:512-689-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y012Medicare PIN