Provider Demographics
NPI:1316984222
Name:PADDOCK, JULIE F (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:F
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305
Mailing Address - Country:US
Mailing Address - Phone:303-499-0109
Mailing Address - Fax:
Practice Address - Street 1:2600 CAMPUS DR
Practice Address - Street 2:A
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3357
Practice Address - Country:US
Practice Address - Phone:303-673-1900
Practice Address - Fax:303-673-1915
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26838207Q00000X
MT10095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01268382Medicaid
COCO300179Medicare PIN
COC524328Medicare PIN
D24855Medicare UPIN
COC373858Medicare PIN