Provider Demographics
NPI:1053311167
Name:JULIS, RONALD E (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:JULIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 CLAREMONT WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3329
Mailing Address - Country:US
Mailing Address - Phone:707-252-0313
Mailing Address - Fax:707-252-0320
Practice Address - Street 1:3273 CLAREMONT WAY STE 201
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3329
Practice Address - Country:US
Practice Address - Phone:707-252-0313
Practice Address - Fax:707-252-0320
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2013-08-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
CAOOG273880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG273880OtherSTATE LICENCE NUMBER
CA942579834OtherFEDERAL TAX ID NUMBER
CAA43339Medicare UPIN