Provider Demographics
NPI:1952499774
Name:COUTOUMANOS, JULIA F (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:F
Last Name:COUTOUMANOS
Suffix:
Gender:F
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 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7437
Practice Address - Street 1:731 MARTIN RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2703
Practice Address - Country:US
Practice Address - Phone:817-514-0346
Practice Address - Fax:817-514-0885
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398692OtherPHCS PIN
TX00U87ZOtherBCBSTX GRP PIN
TX1640352OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TX045261702Medicaid
TX4048150OtherCIGNA PNI
TX045261703OtherCSHCN
TX1392456OtherUHC PIN
TX4543046OtherAETNA PIN
TXCOUJG30286OtherCCHIP PIN
TX86W435OtherBCBSTX IND PIN
G30286Medicare UPIN
TX045261703OtherCSHCN