Basic Information
| Provider Information | |||||||||
| NPI: | 1104091909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAUL M. JULIEN PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 808 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058550808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023349009 | ||||||||
| FaxNumber: | 8023349022 | ||||||||
| Practice Location | |||||||||
| Address1: | 637 UNION ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058555498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023349009 | ||||||||
| FaxNumber: | 8023349022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | JULIEN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8023349009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 042-0010859 | VT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1011153 | 05 | VT | MEDICAID |