Provider Demographics
NPI:1245561109
Name:CARLTON, CHAD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JOSEPH
Last Name:CARLTON
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 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-725-7900
Mailing Address - Fax:682-207-1030
Practice Address - Street 1:5757 WARREN PKWY STE 204
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4206
Practice Address - Country:US
Practice Address - Phone:972-232-7171
Practice Address - Fax:972-674-8360
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5606208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2828006-02Medicaid
TX2828006-01Medicaid
TX282800603Medicaid
TXTXB131763Medicare PIN
TX2828006-01Medicaid