1528082393 NPI number — ROBERT D JULIAN MD

Table of content: ROBERT D JULIAN MD (NPI 1528082393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528082393 NPI number — ROBERT D JULIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JULIAN
Provider First Name:
ROBERT
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528082393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 SAINT MICHAEL DR STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-614-5353
Provider Business Mailing Address Fax Number:
903-614-5343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1659 HIGHWAY 46 W STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-387-4991
Provider Business Practice Location Address Fax Number:
831-387-5004
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H0507 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84V312 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1186100001 . This is a "PALMETTO DMERC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H0507 . This is a "UNICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 116309100 . This is a "FIRST CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1186100001 . This is a "DMERC CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 140013712 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0507 . This is a "WORKERS COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 116309100 . This is a "SOUTHWEST LIFE & HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 80062157 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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