Provider Demographics
NPI:1841392552
Name:ANTHONY, JULIAN N (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:N
Last Name:ANTHONY
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:PO BOX 25100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5100
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-326-1230
Practice Address - Street 1:1955 CITRACADO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4112
Practice Address - Country:US
Practice Address - Phone:760-743-4789
Practice Address - Fax:858-673-5187
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82316208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100000Medicaid
CAZZZ65165ZOtherBLUE SHIELD
H95007Medicare UPIN
CADI608XMedicare PIN
CAW18682Medicare ID - Type Unspecified