Provider Demographics
NPI:1780663476
Name:IGLESIAS, JULIO E (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:E
Last Name:IGLESIAS
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 1:301A W BOUNDARY AVE
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-3427
Mailing Address - Country:US
Mailing Address - Phone:318-628-2108
Mailing Address - Fax:318-628-6211
Practice Address - Street 1:301A W BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-3427
Practice Address - Country:US
Practice Address - Phone:318-628-2108
Practice Address - Fax:318-628-6211
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05638R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1317519Medicaid
LAB64240Medicare UPIN
LA1317519Medicaid