Provider Demographics
NPI:1467591719
Name:CARL D'AGOSTINO M.D., LTD.
Entity Type:Organization
Organization Name:CARL D'AGOSTINO M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-620-8888
Mailing Address - Street 1:2407 W LOUISIANA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5807
Mailing Address - Country:US
Mailing Address - Phone:432-620-8888
Mailing Address - Fax:432-620-8187
Practice Address - Street 1:2407 W LOUISIANA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5807
Practice Address - Country:US
Practice Address - Phone:432-620-8888
Practice Address - Fax:432-620-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7460207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5541135OtherAETNA
TX0050EAOtherBLUE CROSS BLUE SHIELD
TX=========OtherUNICARE
TX5541135OtherAETNA
TX=========OtherUNICARE