Provider Demographics
NPI:1649218348
Name:DUBEA, JULIE MICHELLE (LOTR, CHT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MICHELLE
Last Name:DUBEA
Suffix:
Gender:F
Credentials:LOTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:JARREAU
Mailing Address - State:LA
Mailing Address - Zip Code:70749-3003
Mailing Address - Country:US
Mailing Address - Phone:225-627-4300
Mailing Address - Fax:
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-408-7995
Practice Address - Fax:225-408-7989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B413C811Medicare ID - Type Unspecified