Provider Demographics
NPI:1235180506
Name:MCINTOSH, JULIE D (PAC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-9798
Mailing Address - Country:US
Mailing Address - Phone:318-428-6136
Mailing Address - Fax:318-428-6191
Practice Address - Street 1:706 ROSS ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-9798
Practice Address - Country:US
Practice Address - Phone:318-428-6136
Practice Address - Fax:318-428-6191
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPAA10585.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAQ45799Medicare UPIN
LA5F600P520Medicare ID - Type Unspecified