Provider Demographics
NPI:1144252834
Name:SPEED, JULIUS KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:KEITH
Last Name:SPEED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2037
Mailing Address - Country:US
Mailing Address - Phone:601-341-4025
Mailing Address - Fax:
Practice Address - Street 1:300 RAWLS DR STE 600
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2862
Practice Address - Country:US
Practice Address - Phone:601-249-4415
Practice Address - Fax:601-249-4474
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11133207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0114413Medicaid
MS0114413Medicaid
MS25D0320086OtherCLIA
MS080000271Medicare ID - Type Unspecified