Basic Information
| Provider Information | |||||||||
| NPI: | 1083663009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROYHILL | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 278 | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719835260 | ||||||||
| FaxNumber: | 9719835326 | ||||||||
| Practice Location | |||||||||
| Address1: | 1475 MT. HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719835214 | ||||||||
| FaxNumber: | 9719835219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD22733 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine | 173000000X | MD22733 | OR | N | Other Service Providers | Legal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 286706 | 05 | OR | MEDICAID |