Provider Demographics
NPI:1194014530
Name:DESMARAIS, JULIANNA (MD)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:DESMARAIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIANNA
Other - Middle Name:
Other - Last Name:PADAVANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAIL CODE OP09
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8637
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:MAIL CODE OP09
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8637
Practice Address - Fax:503-494-1133
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171187207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program