Provider Demographics
NPI:1124010392
Name:HAYGOOD, JULIE T (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:T
Last Name:HAYGOOD
Suffix:
Gender:F
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:PO BOX 6984
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6984
Mailing Address - Country:US
Mailing Address - Phone:903-360-2109
Mailing Address - Fax:
Practice Address - Street 1:3131 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8350
Practice Address - Country:US
Practice Address - Phone:903-360-2109
Practice Address - Fax:903-561-5576
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7749208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165183802Medicaid
TX8R0580OtherBCBS
TXP00209340OtherRAILROAD MEDICARE
TX165183802Medicaid
TXI03330Medicare UPIN