Provider Demographics
NPI:1497711824
Name:MAYO, JULIE M (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MAYO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1440 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1846
Mailing Address - Country:US
Mailing Address - Phone:605-725-1700
Mailing Address - Fax:605-725-1761
Practice Address - Street 1:1440 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1846
Practice Address - Country:US
Practice Address - Phone:605-725-1700
Practice Address - Fax:605-725-1761
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3622208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6700403Medicaid
SD100380Medicare ID - Type Unspecified
SDE43374Medicare UPIN