Provider Demographics
NPI:1447284443
Name:AREBALO, JULIO (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:AREBALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 HIGHWAY 71 S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-2816
Mailing Address - Country:US
Mailing Address - Phone:979-732-6552
Mailing Address - Fax:979-732-2056
Practice Address - Street 1:1860 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-2816
Practice Address - Country:US
Practice Address - Phone:979-732-6552
Practice Address - Fax:979-732-2056
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8889208600000X
MEMD20717208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039131002Medicaid
P00185146OtherRAILROAD MEDICARE
TX039131002Medicaid
8D1175Medicare PIN