Provider Demographics
NPI:1760465181
Name:MONTOOTH, JULIANA CHRISTINE
Entity type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:CHRISTINE
Last Name:MONTOOTH
Suffix:
Gender:F
Credentials:
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 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-5201
Mailing Address - Fax:
Practice Address - Street 1:6000 KANAKANAK RD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-5201
Practice Address - Fax:907-842-9250
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD44134Medicaid
8EA129Medicare ID - Type Unspecified
8EA133Medicare ID - Type Unspecified
8EA116Medicare ID - Type Unspecified
8EA118Medicare ID - Type Unspecified
8EA122Medicare ID - Type Unspecified
8EA130Medicare ID - Type Unspecified
8EA132Medicare ID - Type Unspecified
H97763Medicare UPIN
8EA128Medicare ID - Type Unspecified
8EA119Medicare ID - Type Unspecified
8EA125Medicare ID - Type Unspecified
8EA117Medicare ID - Type Unspecified
8EA131Medicare ID - Type Unspecified
8EA121Medicare ID - Type Unspecified
8EA124Medicare ID - Type Unspecified
8EA126Medicare ID - Type Unspecified
AKMD44134Medicaid
8EA120Medicare ID - Type Unspecified
8EA127Medicare ID - Type Unspecified