Provider Demographics
NPI:1972524833
Name:JULEAU, JOSEPHINE M (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:M
Last Name:JULEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 E LANCASTER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3836
Mailing Address - Country:US
Mailing Address - Phone:817-413-0943
Mailing Address - Fax:817-413-6481
Practice Address - Street 1:4732 E LANCASTER AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3836
Practice Address - Country:US
Practice Address - Phone:817-413-0943
Practice Address - Fax:817-413-6481
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8708OtherBLUE CROSS BLUE SHIELD
TX182482302Medicaid
TX8L2661Medicare PIN