Provider Demographics
NPI:1063476877
Name:MACIAS, CARLOS L (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:L
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:L
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:909 9TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-335-1131
Mailing Address - Fax:817-335-2514
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-335-1131
Practice Address - Fax:817-335-2514
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2172208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8HT407OtherBCBSTX
TX105424901Medicaid
TXG66187Medicare UPIN