Provider Demographics
NPI:1790873834
Name:JULIE T HAYGOOD MD PA
Entity Type:Organization
Organization Name:JULIE T HAYGOOD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAYGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-360-2109
Mailing Address - Street 1:PO BOX 6984
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6984
Mailing Address - Country:US
Mailing Address - Phone:903-360-2109
Mailing Address - Fax:903-561-5576
Practice Address - Street 1:3131 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8350
Practice Address - Country:US
Practice Address - Phone:903-360-2109
Practice Address - Fax:903-561-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7749207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDD1178OtherRAILROAD MEDICARE
TX0098LZOtherBCBS
TX170200301Medicaid
TX0098LZOtherBCBS