Provider Demographics
NPI:1437353091
Name:FRIDLINGTON, JULIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:FRIDLINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:131 W SUNSET RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2797
Mailing Address - Country:US
Mailing Address - Phone:210-255-8447
Mailing Address - Fax:210-255-8446
Practice Address - Street 1:121 BULVERDE CROSSING RD STE 110
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-6201
Practice Address - Country:US
Practice Address - Phone:830-380-3031
Practice Address - Fax:210-255-8446
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3034207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05934890Medicaid
3851910234OtherMYUTMB 3851910234-COMMERCIAL NUMBER
TXTXB106999Medicare PIN
3851910234OtherMYUTMB 3851910234-COMMERCIAL NUMBER