MEDICARE: DR. JULIE A MERRIAM DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO27966	OR
2	207Q00000X	Family Medicine Physician	OP60126252	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184612962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A MERRIAM DO

Provider Business Mailing Address
First Line	:	1400 E. KINCAID STREET
Second Line	:	ATTN: CREDENTIALING
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-2500
Fax Number	:	360-428-6485

Provider Business Practice Location Address
First Line	:	2209 E. 32ND ST.
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98404
Country	:	US
Telephone Number	:	253-593-0232
Fax Number	:	253-593-3311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	08/28/2017

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