Provider Demographics
NPI:1942226436
Name:CARBO, ALBERTO IVO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:IVO
Last Name:CARBO
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 1:1512 W KIRBY PL
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3822
Mailing Address - Country:US
Mailing Address - Phone:318-675-7636
Mailing Address - Fax:318-675-7531
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-7636
Practice Address - Fax:318-675-7531
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14984R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4F214F600OtherMEDICARE PTAN
LA1155276Medicaid
LA4F214F600OtherMEDICARE PTAN