=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467475137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULEE K. RICHARDS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 MEDICAL LOOP STE 110
-----------------------------------------------------
City | ROSEBURG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97471-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-440-2165
-----------------------------------------------------
Fax | 541-440-8932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 341 MEDICAL LOOP STE 110
-----------------------------------------------------
City | ROSEBURG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97471-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-440-2165
-----------------------------------------------------
Fax | 541-440-8932
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | MD17078
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------