Provider Demographics
NPI:1528128915
Name:TATUM HUNTER, JULIA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ANNE
Last Name:TATUM HUNTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:ANNE
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1102 A1A N STE 104
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4098
Mailing Address - Country:US
Mailing Address - Phone:310-247-8744
Mailing Address - Fax:310-247-0181
Practice Address - Street 1:1102 FLORIDA A1A NORTH
Practice Address - Street 2:DR. OZDEMIR OFFICE ST 104
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:310-247-8744
Practice Address - Fax:310-247-0181
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69549207LP2900X, 207R00000X
CAME148252207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G659491Medicaid
CAG69549AMedicare PIN