Provider Demographics
NPI:1245212539
Name:CORRAL, CARLOS HUMBERTO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:HUMBERTO
Last Name:CORRAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL STE 280
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1717
Mailing Address - Country:US
Mailing Address - Phone:720-321-8680
Mailing Address - Fax:720-321-8681
Practice Address - Street 1:11700 W 2ND PL STE 280
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1717
Practice Address - Country:US
Practice Address - Phone:720-321-8680
Practice Address - Fax:720-321-8681
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2120208G00000X
NM90170208G00000X
CO59284208G00000X
MT101130208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000X3247OtherSALUD PROGRAMS MEDICAID
330003968OtherRAILROAD MEDICARE
TX122858703Medicaid
NM900522525OtherMEDICARE GROUP
330003968OtherRAILROAD MEDICARE
C147799Medicare UPIN