Provider Demographics
NPI:1154407740
Name:JULIE E YORK MD PC
Entity type:Organization
Organization Name:JULIE E YORK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-561-7240
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:SUITE 5085
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3975
Mailing Address - Country:US
Mailing Address - Phone:503-561-7240
Mailing Address - Fax:503-561-7245
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 5085
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-561-7240
Practice Address - Fax:503-561-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26552207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247330Medicaid
ORH21116Medicare UPIN
OR247330Medicaid