Provider Demographics
NPI:1447280987
Name:SEO, UN SOK (MD UN)
Entity type:Individual
Prefix:
First Name:UN
Middle Name:SOK
Last Name:SEO
Suffix:
Gender:F
Credentials:MD UN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:SOK
Other - Last Name:SEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-0569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-9700
Practice Address - Country:US
Practice Address - Phone:541-942-0511
Practice Address - Fax:541-942-0353
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25947207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213550Medicaid
I36242Medicare UPIN
ORR132050Medicare PIN