Provider Demographics
NPI:1932104676
Name:COLYER, JULIET JANE (DPM)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:JANE
Last Name:COLYER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S 41ST ST E
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-6253
Mailing Address - Country:US
Mailing Address - Phone:918-781-6582
Mailing Address - Fax:918-681-1908
Practice Address - Street 1:1001 S 41ST ST E
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-6253
Practice Address - Country:US
Practice Address - Phone:918-781-6582
Practice Address - Fax:918-681-1908
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202213E00000X
NYN005298213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100779450AMedicaid
OK100849930BMedicaid
U63067Medicare UPIN
OK100779450AMedicaid
U63067Medicare UPIN