Provider Demographics
NPI:1629038724
Name:JULIAN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:JULIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620
Mailing Address - Country:US
Mailing Address - Phone:812-838-2231
Mailing Address - Fax:812-838-4628
Practice Address - Street 1:1900 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620
Practice Address - Country:US
Practice Address - Phone:812-838-2231
Practice Address - Fax:812-838-4628
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN61625379A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100210120AMedicaid
IN000000042339OtherBLUE CROSS
IN100210120AMedicaid
IN660410Medicare ID - Type Unspecified