Provider Demographics
NPI:1952340663
Name:BURDIN, JULIE L (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:BURDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:L
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2095
Mailing Address - Country:US
Mailing Address - Phone:660-385-8700
Mailing Address - Fax:660-385-8701
Practice Address - Street 1:1201 N RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2020
Practice Address - Country:US
Practice Address - Phone:660-385-8900
Practice Address - Fax:660-385-8708
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD2000161370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205853807Medicaid
MO205853807Medicaid
MOH48248Medicare UPIN