Provider Demographics
NPI:1952662363
Name:KNARREBORG, JULIA DRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:DRY
Last Name:KNARREBORG
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:COLLEGE OF MEDICINE, PO BOX 2690
Mailing Address - Street 2:GARRISON TOWER, SUITE 4G4250
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126
Mailing Address - Country:US
Mailing Address - Phone:405-271-8000
Mailing Address - Fax:
Practice Address - Street 1:1817 ROCKY MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4640
Practice Address - Country:US
Practice Address - Phone:972-533-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK300192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program