MEDICARE: DR. JULIA ELLEN MCNABB D.O.

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	DO 107000	MO

General Provider Information

NPI Number	:	1669532727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA ELLEN MCNABB D.O.

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	QUEEN CITY
State	:	MO
Zip	:	63561-0040
Country	:	US
Telephone Number	:	660-766-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 N OLIVE ST
Second Line	:
City	:	QUEEN CITY
State	:	MO
Zip	:	63561
Country	:	US
Telephone Number	:	660-766-2300
Fax Number	:	626-593-4791

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/12/2019

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