Provider Demographics
NPI:1053377986
Name:LEARY, JULIUS LENWOOD JR (MD)
Entity type:Individual
Prefix:
First Name:JULIUS
Middle Name:LENWOOD
Last Name:LEARY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LINER DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-227-6371
Mailing Address - Fax:864-227-6345
Practice Address - Street 1:106 LINER DRIVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-227-6371
Practice Address - Fax:864-227-6345
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC103890Medicaid
D991901258Medicare ID - Type Unspecified
D99190Medicare UPIN