Provider Demographics
NPI:1285675306
Name:CHAKMAKJIAN, CARL G (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:CHAKMAKJIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1700 W HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-2452
Practice Address - Country:US
Practice Address - Phone:254-399-0741
Practice Address - Fax:254-399-0779
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4879207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S3359OtherBLUE CROSS OF TEXAS
TX8G4449Medicare PIN
TXP00220979Medicare PIN
TX8S3359OtherBLUE CROSS OF TEXAS
TX8D5259Medicare PIN