Provider Demographics
NPI:1093794265
Name:GRAVES, JULIE DEAUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:DEAUN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:GRAVES
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8000 WEST DR APT 314
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5663
Mailing Address - Country:US
Mailing Address - Phone:512-689-8001
Mailing Address - Fax:
Practice Address - Street 1:8000 WEST DR APT 314
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-5663
Practice Address - Country:US
Practice Address - Phone:512-689-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD84791207Q00000X
TXG5110207Q00000X, 207Q00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136267534Medicaid
TX136267531Medicaid
TXP00656758Medicare PIN
TXC19093Medicare UPIN
TX8L4056Medicare PIN
TXF5905Medicare PIN
TX136267534Medicaid
TX8L4041Medicare PIN