Provider Demographics
NPI:1427060078
Name:WILSON, JULIE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD STE 307
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2972
Mailing Address - Country:US
Mailing Address - Phone:907-777-1850
Mailing Address - Fax:855-468-1357
Practice Address - Street 1:2741 DEBARR RD STE 307
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2972
Practice Address - Country:US
Practice Address - Phone:907-777-1850
Practice Address - Fax:855-468-1357
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1009555Medicaid
AK160637Medicare PIN
AKMD10856Medicaid