Provider Demographics
NPI:1164999595
Name:BRANCH, JULIAN EDWARD
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:EDWARD
Last Name:BRANCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 MOLLIE RAUSCH LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2536
Mailing Address - Country:US
Mailing Address - Phone:405-824-7538
Mailing Address - Fax:
Practice Address - Street 1:1012 MOLLIE RAUSCH LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2536
Practice Address - Country:US
Practice Address - Phone:405-824-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist