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General NPI Number Information
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NPI Number | 1790873834
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Entity Type | Organization
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Legal Business Name | JULIE T HAYGOOD MD PA
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 3131 TROUP HWY
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City | TYLER
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State | TX
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Zip | 75701-8350
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Country | US
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Telephone | 903-360-2109
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Fax | 903-561-5576
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Provider Business Mailing Address
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Address Line | PO BOX 6984
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City | TYLER
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State | TX
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Zip | 75711-6984
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Country | US
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Telephone | 903-360-2109
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Fax | 903-561-5576
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Authorized Official
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Title or Position | OWNER
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Name | JULIE T HAYGOOD
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Credential | M.D.
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Telephone | 906-360-2109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | L7749
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License Number State | TX
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