Provider Demographics
NPI:1821451667
Name:L. NATALIE CARROLL, M.D. P A
Entity Type:Organization
Organization Name:L. NATALIE CARROLL, M.D. P A
Other - Org Name:LAVERNE NATALIE CARROLL,M.D. P A
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:L
Authorized Official - Middle Name:NATALIE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD P A
Authorized Official - Phone:713-667-3999
Mailing Address - Street 1:2656 S LOOP W
Mailing Address - Street 2:SUITE 575
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5622
Mailing Address - Country:US
Mailing Address - Phone:713-667-3999
Mailing Address - Fax:713-522-2247
Practice Address - Street 1:2656 S LOOP W STE 575
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5622
Practice Address - Country:US
Practice Address - Phone:713-667-3999
Practice Address - Fax:713-522-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123588905Medicaid
TX1821451667OtherNPI
TX1821451667OtherNPI