Provider Demographics
NPI:1922011287
Name:SOUTHMAYD, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SOUTHMAYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 9TH ST N STE 306
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5878
Mailing Address - Country:US
Mailing Address - Phone:239-624-0340
Mailing Address - Fax:239-624-0341
Practice Address - Street 1:311 9TH ST N STE 306
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5878
Practice Address - Country:US
Practice Address - Phone:239-624-0340
Practice Address - Fax:239-624-0341
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01224100OtherRAILROAD
FL44235OtherBCBS
FL44235ROtherMEDICARE
FL12792Medicare PIN
FLP01224100OtherRAILROAD