Provider Demographics
NPI:1376596130
Name:DAHLBERG, CARL G W (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:G W
Last Name:DAHLBERG
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:DEPT 794
Mailing Address - Street 2:PO BOX 4346
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:713-255-4000
Mailing Address - Fax:713-255-4050
Practice Address - Street 1:COLUMBUS MEDICAL CLINIC
Practice Address - Street 2:2122 HWY 71 S
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934
Practice Address - Country:US
Practice Address - Phone:979-732-2318
Practice Address - Fax:979-732-2310
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH3559207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1141OtherBLUE CROSS PROV #
TX4104575OtherAETNA PROVIDER #
TXP00184430OtherRAILROAD MEDICARE NUMBER
TX102112303Medicaid
TX4104575OtherAETNA PROVIDER #