Basic Information
| Provider Information | |||||||||
| NPI: | 1003010869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9429 N 50TH ST W | ||||||||
| Address2: | |||||||||
| City: | PORTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744542749 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9429 N 50TH ST W | ||||||||
| Address2: | |||||||||
| City: | PORTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744542749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188697388 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20769 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.