Provider Demographics
NPI:1972597078
Name:VERDE, JULIAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:N
Last Name:VERDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-7279
Mailing Address - Country:US
Mailing Address - Phone:696-282-0184
Mailing Address - Fax:696-282-9852
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:STE. 250
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6835
Practice Address - Country:US
Practice Address - Phone:314-567-4449
Practice Address - Fax:314-567-0762
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO286542085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1600278OtherUNITED HEALTHCARE
1600026OtherUNITED HEALTHCARE
1600141OtherUNITED HEALTHCARE
1600137OtherUNITED HEALTHCARE
1600026OtherUNITED HEALTHCARE