Provider Demographics
NPI:1568438984
Name:FASTABEND, CARL P (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:P
Last Name:FASTABEND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 KATY FWY STE 115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2105
Mailing Address - Country:US
Mailing Address - Phone:281-888-1464
Mailing Address - Fax:713-640-5938
Practice Address - Street 1:11221 KATY FWY STE 115
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2105
Practice Address - Country:US
Practice Address - Phone:281-888-1464
Practice Address - Fax:713-640-5938
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04492R207RC0000X
TXU2699207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1193887Medicaid
LA1193887Medicaid
5J4837460Medicare PIN
060018475Medicare PIN