Provider Demographics
NPI:1700846268
Name:TABBS, CARLA R (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:TABBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 N TARRANT PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5413
Mailing Address - Country:US
Mailing Address - Phone:817-431-4471
Mailing Address - Fax:817-562-3198
Practice Address - Street 1:3912 N TARRANT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5413
Practice Address - Country:US
Practice Address - Phone:817-431-4471
Practice Address - Fax:817-562-3198
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0262207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09599801Medicaid
00270MMedicare ID - Type Unspecified
TX09599801Medicaid