Provider Demographics
NPI:1891850814
Name:JULEE RICHARDS MD PC
Entity Type:Organization
Organization Name:JULEE RICHARDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULEE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-440-2165
Mailing Address - Street 1:341 MEDICAL LOOP
Mailing Address - Street 2:STE 110
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5546
Mailing Address - Country:US
Mailing Address - Phone:541-440-2165
Mailing Address - Fax:541-440-8932
Practice Address - Street 1:341 MEDICAL LOOP
Practice Address - Street 2:STE 110
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5546
Practice Address - Country:US
Practice Address - Phone:541-440-2165
Practice Address - Fax:541-440-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17078207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR070016168OtherRR MEDICARE PIN
ORR112629OtherMEDICARE INDIVIDUAL PIN
OR804708001OtherBLUE CROSS BLUE SHIELD
ORCJ9890OtherRR MEDICARE GROUP
OR026463Medicaid
ORA95024Medicare UPIN
ORR112608Medicare PIN