Provider Demographics
NPI:1164483293
Name:LO, CARSON TAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARSON
Middle Name:TAN
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 19814
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77224-9814
Mailing Address - Country:US
Mailing Address - Phone:281-599-3222
Mailing Address - Fax:281-599-3016
Practice Address - Street 1:1331 W GRAND PARKWAY N
Practice Address - Street 2:SUITE 310
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2711
Practice Address - Country:US
Practice Address - Phone:713-827-8434
Practice Address - Fax:281-599-3016
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK0112207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100651203Medicaid
TX100651203Medicaid
8A1110Medicare PIN