Provider Demographics
NPI:1356632129
Name:MAENDEL, JULIAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:DAVID
Last Name:MAENDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:106 BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2340
Mailing Address - Country:US
Mailing Address - Phone:719-589-8073
Mailing Address - Fax:910-772-9452
Practice Address - Street 1:106 BLANCA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2340
Practice Address - Country:US
Practice Address - Phone:719-589-8073
Practice Address - Fax:719-589-8087
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2021-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0058226208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1356632129Medicaid