Provider Demographics
NPI:1083688659
Name:PERRY, JULIE M (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:PERRY-WHEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1612 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6519
Mailing Address - Country:US
Mailing Address - Phone:707-468-9030
Mailing Address - Fax:707-468-4313
Practice Address - Street 1:999 ADAMS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1148
Practice Address - Country:US
Practice Address - Phone:707-963-8898
Practice Address - Fax:707-963-1775
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48035207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G480350OtherBLUE SHIELD
CA00G480351Medicaid
CA4700110001OtherMEDICARE DMERC
CA00G480350Medicare ID - Type Unspecified
CA00G480351Medicaid