Provider Demographics
NPI:1801072129
Name:JULIAN, CHRISTIE A (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:A
Last Name:JULIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:J
Other - Last Name:ATWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:1072 N LIBERTY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8708
Practice Address - Country:US
Practice Address - Phone:208-367-4321
Practice Address - Fax:208-367-4525
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6837682-1205208000000X
IDM-10732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics