Provider Demographics
NPI:1659318095
Name:NUESCH, CARL E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:NUESCH
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:6204 BALCONES DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4214
Practice Address - Country:US
Practice Address - Phone:512-302-1771
Practice Address - Fax:512-302-9774
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH19052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138225110Medicaid
TX138225112Medicaid
NM000P3688Medicaid
TX138225101Medicaid
TX8R1515OtherBLUE CROSS OF TEXAS
TX138225111Medicaid
TX138225104Medicaid
TX138225102Medicaid
TX138225105Medicaid
TX138225108Medicaid
TX138225109Medicaid
TX138225103Medicaid
TX138225106Medicaid
TX138225107Medicaid
TX87693KMedicare PIN
TX138225110Medicaid
TX8R1515OtherBLUE CROSS OF TEXAS
TX138225103Medicaid
TX8D5767Medicare PIN
TX138225105Medicaid
TX138225107Medicaid