Provider Demographics
NPI:1063479707
Name:CHARLIE, JULIUS RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:RAY
Last Name:CHARLIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 W FAIRVIEW ST
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4712
Mailing Address - Country:US
Mailing Address - Phone:480-800-4980
Mailing Address - Fax:480-427-4766
Practice Address - Street 1:6944 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-1916
Practice Address - Country:US
Practice Address - Phone:480-800-4890
Practice Address - Fax:480-427-4766
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-08392084N0400X
AZ405192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ865090Medicaid