Provider Demographics
NPI:1447249636
Name:JULIAN, CARMEN (DO)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:JULIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S CAMINO DEL RIO, STE B
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303
Mailing Address - Country:US
Mailing Address - Phone:214-420-0650
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:523 S CAMINO DEL RIO, STE B
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-247-1970
Practice Address - Fax:970-259-1668
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73012207N00000X
TXM4224207N00000X, 207P00000X
OH34008228J207P00000X
CODR.0068954207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000210814Medicaid
TXP00411411Medicare PIN
TX8G6922Medicare PIN