Provider Demographics
NPI:1396792073
Name:JUVILER, ADAM HERZ (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:HERZ
Last Name:JUVILER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:9922 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1126
Practice Address - Country:US
Practice Address - Phone:509-747-6194
Practice Address - Fax:509-838-0824
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044600208600000X, 208C00000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1009436Medicaid
WA0305788OtherLABOR & INDISTRIES
WAP01172762OtherRAILROAD MEDICARE
WA1009436Medicaid