Healthcare Provider Details

I. General information

NPI: 1720280639
Provider Name (Legal Business Name): JULIE ADAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

1234 BIG BEND CROSSING DR
VALLEY PARK MO
63088-1276
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8782
  • Fax:
Mailing address:
  • Phone: 636-825-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2006018681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: