Provider Demographics
NPI:1730156902
Name:VAILS, JULIE L (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:VAILS
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 1:1322 SHOREWAY RD
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-3016
Mailing Address - Country:US
Mailing Address - Phone:712-213-1322
Mailing Address - Fax:
Practice Address - Street 1:1322 SHOREWAY RD
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3016
Practice Address - Country:US
Practice Address - Phone:712-213-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA749521207Q00000X, 207VX0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A749521Medicaid
CA034433OtherHILL PHYSICIANS MED GROUP
CA710908889OtherSUTTER MEDICAL GROUP
CAP00051481OtherMEDICARE RAIL ROAD
CA000A749521Medicaid
CA710908889OtherSUTTER MEDICAL GROUP