Provider Demographics
NPI:1265409668
Name:VAN BURKLEO, JULIA B (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:B
Last Name:VAN BURKLEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 847176
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7176
Mailing Address - Country:US
Mailing Address - Phone:903-237-1800
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:1111 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5537
Practice Address - Country:US
Practice Address - Phone:903-753-7658
Practice Address - Fax:903-236-0385
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC6542207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113723405Medicaid
TXD69214Medicare UPIN
TXTXB147316Medicare PIN