Provider Demographics
NPI:1871674093
Name:CARLIN, BRIAN TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:CARLIN
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 1:808 HYLANE STREET
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5608
Mailing Address - Country:US
Mailing Address - Phone:939-853-8249
Mailing Address - Fax:939-853-8220
Practice Address - Street 1:6844 U.S. HWY 69 NORTH
Practice Address - Street 2:LUFKIN STATE SCHOOL
Practice Address - City:POLLOK
Practice Address - State:TX
Practice Address - Zip Code:75969
Practice Address - Country:US
Practice Address - Phone:936-853-8249
Practice Address - Fax:936-853-8220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
83G791Medicare ID - Type Unspecified
TXB21697Medicare UPIN