Provider Demographics
NPI:1316033988
Name:CARL U WESTBROOK, II, MD, PA
Entity Type:Organization
Organization Name:CARL U WESTBROOK, II, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:U
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:903-597-7070
Mailing Address - Street 1:1324 SOUTH BECKHAM
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-597-7070
Mailing Address - Fax:903-597-7068
Practice Address - Street 1:1324 SOUTH BECKHAM
Practice Address - Street 2:SUITE 207
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-597-7070
Practice Address - Fax:903-597-7068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARL U WESTBROOK, II, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0376207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27499Medicare UPIN