Provider Demographics
NPI:1184612962
Name:MERRIAM, JULIE A (DO)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E. KINCAID STREET
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:2209 E. 32ND ST.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404
Practice Address - Country:US
Practice Address - Phone:253-593-0232
Practice Address - Fax:253-593-3311
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO27966207Q00000X
WAOP60126252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2004382Medicaid
WAH72259Medicare UPIN