Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 36161 | CA |
N | 1223P0106X | Oral and Maxillofacial Pathology | 36161 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 36161 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A063994 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | A063994 | CA |
N | 2086S0127X | Trauma Surgeon | A063994 | CA |
NPI | 1427119791 |
---|---|
Provider Name | Dr. Robert S Julian III |
First Address | Fresno, CA 93701-2124 |
Second Address | Fresno, CA 93701-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 21/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043403207 | MEDICARE - BILLING PROVIDER (01) | CA |
1427119791 | MEDICARE - RENDERING/INDIVIDUAL PROV (01) | CA |
36161 | DENTAL LICENSE (01) | CA |
63994 | (05) | CA |
A63994 | MEDICAL LICENSE (01) | CA |
B36161 | DENTICAL PROVIDER # (01) | CA |
BJ4609864 | DEA NUMBER (01) | CA |
G17733 | (02) | CA |
GA 1120 | GENERAL ANESTHESIA LIC (01) | CA |