Provider Demographics
NPI:1477598969
Name:DEESE, JULIAN VANLANDINGHAM (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:VANLANDINGHAM
Last Name:DEESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5171
Mailing Address - Country:US
Mailing Address - Phone:903-212-3262
Mailing Address - Fax:
Practice Address - Street 1:3209 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5171
Practice Address - Country:US
Practice Address - Phone:903-212-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7442207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115487404Medicaid
C15152Medicare UPIN
TX8G7709Medicare Oscar/Certification