Provider Demographics
NPI:1548589815
Name:CARO, AMANDA ROSE (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:CARO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 61160
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1160
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:361-857-0572
Practice Address - Street 1:6182 DUNBARTON OAK ST STE B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4276
Practice Address - Country:US
Practice Address - Phone:361-452-9320
Practice Address - Fax:361-452-9321
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2019-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN5607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5607OtherMEDICAL LICENSE
TX293416YRQ8OtherMEDICARE PTAN
TXTXB141257Medicare PIN