Provider Demographics
NPI:1831681956
Name:SPEROS, JULIA PHIPPS (PA-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PHIPPS
Last Name:SPEROS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:PHIPPS
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2525 NW LOVEJOY ST
Mailing Address - Street 2:STE 400
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2865
Mailing Address - Country:US
Mailing Address - Phone:503-223-1933
Mailing Address - Fax:503-223-1947
Practice Address - Street 1:417 SW 117TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5924
Practice Address - Country:US
Practice Address - Phone:503-216-9400
Practice Address - Fax:503-216-9499
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA195712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine