Provider Demographics
NPI:1093769523
Name:CARNES, CHRISTINA L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:CARNES
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 181956
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-8956
Mailing Address - Country:US
Mailing Address - Phone:214-693-3052
Mailing Address - Fax:214-377-8392
Practice Address - Street 1:547 AQUA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2105
Practice Address - Country:US
Practice Address - Phone:214-693-3052
Practice Address - Fax:214-377-8392
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH70961Medicare UPIN