Provider Demographics
| NPI: | 1760465181 |
|---|---|
| Name: | MONTOOTH, JULIANA CHRISTINE |
| Entity Type: | Individual |
| Prefix: | DR |
| First Name: | JULIANA |
| Middle Name: | CHRISTINE |
| Last Name: | MONTOOTH |
| Suffix: | |
| Gender: | F |
| Credentials: | |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | PO BOX 130 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DILLINGHAM |
| Mailing Address - State: | AK |
| Mailing Address - Zip Code: | 99576-0130 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 907-842-5201 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 6000 KANAKANAK RD |
| Practice Address - Street 2: | |
| Practice Address - City: | DILLINGHAM |
| Practice Address - State: | AK |
| Practice Address - Zip Code: | 99576 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 907-842-5201 |
| Practice Address - Fax: | 907-842-9250 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2005-11-21 |
| Last Update Date: | 2012-02-29 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AK | 4940 | 207Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AK | MD44134 | Medicaid | |
| 8EA129 | Medicare ID - Type Unspecified | ||
| 8EA133 | Medicare ID - Type Unspecified | ||
| 8EA116 | Medicare ID - Type Unspecified | ||
| 8EA118 | Medicare ID - Type Unspecified | ||
| 8EA122 | Medicare ID - Type Unspecified | ||
| 8EA130 | Medicare ID - Type Unspecified | ||
| 8EA132 | Medicare ID - Type Unspecified | ||
| H97763 | Medicare UPIN | ||
| 8EA128 | Medicare ID - Type Unspecified | ||
| 8EA119 | Medicare ID - Type Unspecified | ||
| 8EA125 | Medicare ID - Type Unspecified | ||
| 8EA117 | Medicare ID - Type Unspecified | ||
| 8EA131 | Medicare ID - Type Unspecified | ||
| 8EA121 | Medicare ID - Type Unspecified | ||
| 8EA124 | Medicare ID - Type Unspecified | ||
| 8EA126 | Medicare ID - Type Unspecified | ||
| AK | MD44134 | Medicaid | |
| 8EA120 | Medicare ID - Type Unspecified | ||
| 8EA127 | Medicare ID - Type Unspecified |
