Provider Demographics
NPI:1376505206
Name:DETEMPLE, JULIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:DETEMPLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1310
Mailing Address - Country:US
Mailing Address - Phone:304-720-3555
Mailing Address - Fax:304-720-3556
Practice Address - Street 1:509 2ND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1310
Practice Address - Country:US
Practice Address - Phone:304-720-3555
Practice Address - Fax:304-720-3556
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0206415000OtherGROUP MEDICAID
WV9328971OtherMEDICARE GROUP
WV1801448000Medicaid
WVH22085Medicare UPIN