Provider Demographics
NPI:1558385252
Name:VENEGAS, CARLOS L (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:L
Last Name:VENEGAS
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 1:8222 DOUGLAS AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5923
Mailing Address - Country:US
Mailing Address - Phone:214-363-5400
Mailing Address - Fax:214-363-5411
Practice Address - Street 1:8222 DOUGLAS AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5923
Practice Address - Country:US
Practice Address - Phone:214-363-5400
Practice Address - Fax:214-363-5411
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8169Medicare ID - Type Unspecified