Provider Demographics
NPI:1114056215
Name:MERY, CARLOS MIGUEL (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MIGUEL
Last Name:MERY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:MIGUEL
Other - Last Name:MERY SUAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:4900 MUELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3079
Mailing Address - Country:US
Mailing Address - Phone:855-324-0091
Mailing Address - Fax:
Practice Address - Street 1:4900 MUELLER BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3079
Practice Address - Country:US
Practice Address - Phone:855-324-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8953208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX701973OtherMEDICARE