Provider Demographics
NPI:1598430811
Name:BAELE, JULIET X (MD)
Entity type:Individual
Prefix:DR
First Name:JULIET
Middle Name:
Last Name:BAELE
Suffix:X
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 NE EVERGREEN PKWY APT 147
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7875
Mailing Address - Country:US
Mailing Address - Phone:971-777-3545
Mailing Address - Fax:
Practice Address - Street 1:650 NW PERSIMMON PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8390
Practice Address - Country:US
Practice Address - Phone:971-777-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2084P0800X1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
66543201OtherPRIVATE PRACTICE