Provider Demographics
NPI:1275510646
Name:MARDOCK, JULIAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:K
Last Name:MARDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:13601 PRESTON RD
Mailing Address - Street 2:SUITE 900W
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4911
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-386-4292
Practice Address - Street 1:4500 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1650
Practice Address - Country:US
Practice Address - Phone:972-547-8190
Practice Address - Fax:972-547-8196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE6492207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24632Medicare UPIN
TX89115KMedicare ID - Type Unspecified606K
TX84714KMedicare ID - Type Unspecified339K
TX89580KMedicare ID - Type Unspecified607K