Provider Demographics
NPI:1851450324
Name:CARVAJAL, ADOLFO (MD)
Entity Type:Individual
Prefix:
First Name:ADOLFO
Middle Name:
Last Name:CARVAJAL
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 1:4545 FULLER DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6521
Mailing Address - Country:US
Mailing Address - Phone:972-870-5511
Mailing Address - Fax:
Practice Address - Street 1:4545 FULLER DR
Practice Address - Street 2:SUITE 325
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6521
Practice Address - Country:US
Practice Address - Phone:972-870-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine