Provider Demographics
NPI:1700844750
Name:LEN, JULIO E (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:E
Last Name:LEN
Suffix:
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:PO BOX 612526
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75261-2526
Mailing Address - Country:US
Mailing Address - Phone:972-786-0330
Mailing Address - Fax:972-739-2894
Practice Address - Street 1:3501 N MACARTHUR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3649
Practice Address - Country:US
Practice Address - Phone:972-484-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121345605Medicaid