Provider Demographics
NPI:1386093417
Name:REESE, JULIAN FLOYD III (DO)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:FLOYD
Last Name:REESE
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 ARDEN AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4014
Mailing Address - Country:US
Mailing Address - Phone:818-400-2631
Mailing Address - Fax:866-887-3856
Practice Address - Street 1:435 ARDEN AVE STE 310
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4014
Practice Address - Country:US
Practice Address - Phone:818-247-6676
Practice Address - Fax:866-887-3856
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39356207R00000X
CA20A23041207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC393569Medicaid