Provider Demographics
NPI:1457091027
Name:CARNIVORE LIFESTYLE MD PLLC
Entity Type:Organization
Organization Name:CARNIVORE LIFESTYLE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-220-8063
Mailing Address - Street 1:10857 KUYKENDAHL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2936
Mailing Address - Country:US
Mailing Address - Phone:346-220-8063
Mailing Address - Fax:832-838-4362
Practice Address - Street 1:3275 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4501
Practice Address - Country:US
Practice Address - Phone:346-220-8063
Practice Address - Fax:832-838-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty