Provider Demographics
NPI:1073561650
Name:WAIT, JULIETTE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:LOUISE
Last Name:WAIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:9427 SW BARNES RD STE 296
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6667
Practice Address - Country:US
Practice Address - Phone:503-297-3778
Practice Address - Fax:503-297-7853
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3197207RC0200X, 207RP1001X
ORMD24778207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500707189Medicaid
TXP00881737OtherRAILROAD MEDICARE
TX117055704Medicaid
WA2059836Medicaid
OR187832Medicare PIN
WA2059836Medicaid
TX117055704Medicaid
OR500707189Medicaid
TXP00881737OtherRAILROAD MEDICARE