Provider Demographics
NPI:1467475137
Name:RICHARDS, JULEE K (MD)
Entity Type:Individual
Prefix:DR
First Name:JULEE
Middle Name:K
Last Name:RICHARDS
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 1:341 MEDICAL LOOP STE 110
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5546
Mailing Address - Country:US
Mailing Address - Phone:541-440-2165
Mailing Address - Fax:541-440-8932
Practice Address - Street 1:341 MEDICAL LOOP STE 110
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5546
Practice Address - Country:US
Practice Address - Phone:541-440-2165
Practice Address - Fax:541-440-8932
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17078207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR804708001OtherBLUE CROSS
ORR112608OtherMEDICARE GROUP PIN
OR070016168OtherRR MEDICARE PIN
ORCJ9890OtherRR MEDICARE GROUP PIN
OR026463Medicaid
OR804708001OtherBLUE CROSS
OR070016168OtherRR MEDICARE PIN