Provider Demographics
NPI:1154642999
Name:DUCHARME, CARL EDWIN (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:EDWIN
Last Name:DUCHARME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E SOUTHLAKE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6376
Mailing Address - Country:US
Mailing Address - Phone:817-310-6050
Mailing Address - Fax:817-310-6051
Practice Address - Street 1:900 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6376
Practice Address - Country:US
Practice Address - Phone:817-310-6050
Practice Address - Fax:817-310-6051
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6824207R00000X
FLOS12065208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine