Provider Demographics
NPI:1427115617
Name:ARCHER, JULIA J (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:J
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:703 E MARSHALL AVE
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5500
Mailing Address - Country:US
Mailing Address - Phone:903-753-7291
Mailing Address - Fax:903-315-5000
Practice Address - Street 1:703 E MARSHALL AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-753-7291
Practice Address - Fax:903-315-5000
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO8372M05Medicaid
TX8372M1Medicare ID - Type Unspecified
TXPO8372M05Medicaid