Provider Demographics
NPI:1003920521
Name:FOGARTY, JULIE BARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:BARD
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 BRYAN DAIRY RD STE 320
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1256
Mailing Address - Country:US
Mailing Address - Phone:727-394-5650
Mailing Address - Fax:813-635-7939
Practice Address - Street 1:8787 BRYAN DAIRY RD STE 320
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1256
Practice Address - Country:US
Practice Address - Phone:727-394-5650
Practice Address - Fax:813-635-7939
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96090207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00400238OtherRAILROAD MEDICARE NUMBER
FL276634500Medicaid
FLU8980ZMedicare PIN
I65768Medicare UPIN