Provider Demographics
NPI:1245492032
Name:CARR, AIMEE LORELEI (MD)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:LORELEI
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:AIMEE
Other - Middle Name:LORELEI
Other - Last Name:WILTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1650 REPUBLIC PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6917
Mailing Address - Country:US
Mailing Address - Phone:214-691-1902
Mailing Address - Fax:972-696-4190
Practice Address - Street 1:890 ROCKWALL PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6872
Practice Address - Country:US
Practice Address - Phone:972-494-6764
Practice Address - Fax:972-494-6893
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9331208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB135596Medicare PIN
TXTXB135595Medicare PIN