Provider Demographics
NPI:1356637300
Name:FORERO, JULIE FREDERICKSON (DO)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:FREDERICKSON
Last Name:FORERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 W SOUTHLAKE BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6730
Mailing Address - Country:US
Mailing Address - Phone:817-380-5911
Mailing Address - Fax:817-380-5911
Practice Address - Street 1:LARKIN COMMUNITY HOSPITAL
Practice Address - Street 2:7031 SW 62 AVENUE
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-284-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12140207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology