Provider Demographics
NPI:1245439702
Name:COGBURN, JULIA A (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:COGBURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN CREDENTIALING DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:3000 MEDICAL PARK DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4679
Practice Address - Country:US
Practice Address - Phone:813-632-6220
Practice Address - Fax:813-971-5893
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100515207RH0000X, 207RX0202X, 207RX0202X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000081200Medicaid
FL44490OtherBCBS
FL000081200Medicaid
FLAL032YMedicare PIN