=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053435040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERNESTINE AMOI JULYE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25329 INTERSTATE 45 STE B
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-292-3030
-----------------------------------------------------
Fax | 281-292-1418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1141 S CAPE ROYALE DR
-----------------------------------------------------
City | COLDSPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77331-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-653-5405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | L3353
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------