Provider Demographics
NPI:1295716306
Name:GRESHAM, JULIA ANNETTE (PA)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:ANNETTE
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4910
Mailing Address - Country:US
Mailing Address - Phone:480-813-4614
Mailing Address - Fax:
Practice Address - Street 1:13677 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2618
Practice Address - Country:US
Practice Address - Phone:623-882-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1620207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW1436OtherHEALTHNET GRP NUMBER
AZ453051001OtherGROUP HEALTH GRP NUMBER
AZ546301Medicaid
AZ3981220OtherEVERCARE GRP NUMBER
AZ860373636OtherHUMANA GROUP NUMBER
AZ3981220OtherEVERCARE GRP NUMBER
AZ546301Medicaid