Provider Demographics
NPI:1417963257
Name:PALACIOS, CARLOS J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:PALACIOS
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 1:509 W TIDWELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-4356
Mailing Address - Country:US
Mailing Address - Phone:713-691-7490
Mailing Address - Fax:713-691-0079
Practice Address - Street 1:509 W TIDWELL RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-4356
Practice Address - Country:US
Practice Address - Phone:713-691-7490
Practice Address - Fax:713-691-0079
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3820207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040586203Medicaid
TX8F4634Medicare PIN
TX8122N0Medicare PIN
TXG53012Medicare UPIN
TX040588801Medicaid