MEDICARE: JOSEPHINE M JULEAU PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA00192	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y8708	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972524833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE M JULEAU PA

Provider Business Mailing Address
First Line	:	4732 E LANCASTER AVE STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:	817-413-0943
Fax Number	:	817-413-6481

Provider Business Practice Location Address
First Line	:	4732 E LANCASTER AVE STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:	817-413-0943
Fax Number	:	817-413-6481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	05/26/2015

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Directions to “ JOSEPHINE M JULEAU PA” Practice Location

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