Healthcare Provider Details

I. General information

NPI: 1396715215
Provider Name (Legal Business Name): JULIE A TOMBERLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 HUNTERS COURT
MANSFIELD TX
76063
US

IV. Provider business mailing address

PO BOX 120069
ARLINGTON TX
76012
US

V. Phone/Fax

Practice location:
  • Phone: 682-518-8111
  • Fax: 682-518-8112
Mailing address:
  • Phone: 817-274-1999
  • Fax: 817-274-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL 3703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: