Provider Demographics
NPI:1730268459
Name:JUNE, PATRICIA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LEE
Last Name:JUNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1317 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-5809
Mailing Address - Country:US
Mailing Address - Phone:229-985-7177
Mailing Address - Fax:229-890-5373
Practice Address - Street 1:1317 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5809
Practice Address - Country:US
Practice Address - Phone:229-985-7177
Practice Address - Fax:229-890-5373
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA17838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117463OtherPSHP
GA000292025AMedicaid
GA1730268459OtherBLUE CROSS BLUE SHIELD
GAN355136OtherWELLCARE
GAN355136OtherWELLCARE
GAD29888Medicare UPIN