Provider Demographics
NPI:1003825720
Name:CARRO, ANTONIO LAZARO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:LAZARO
Last Name:CARRO
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 1:1004 SE LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1109
Mailing Address - Country:US
Mailing Address - Phone:316-777-0176
Mailing Address - Fax:316-777-1817
Practice Address - Street 1:1004 SE LOUIS DR
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1109
Practice Address - Country:US
Practice Address - Phone:316-777-0176
Practice Address - Fax:316-777-1817
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS057433OtherBC/BS
KSE84244Medicare UPIN
KS057433Medicare ID - Type Unspecified