Provider Demographics
NPI:1427931542
Name:VALE, JUNIPER MAE (MD)
Entity type:Individual
Prefix:
First Name:JUNIPER
Middle Name:MAE
Last Name:VALE
Suffix:
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:PO BOX 170161
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-0161
Mailing Address - Country:US
Mailing Address - Phone:817-404-7481
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 170161
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76003-0161
Practice Address - Country:US
Practice Address - Phone:817-404-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2025-07-28
Deactivation Date:2025-07-23
Deactivation Code:
Reactivation Date:2025-07-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT10104230-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10104230-1205OtherLICENSE NUMBER
UT10104230-8905OtherCS LICENSE NUMBER