Provider Demographics
NPI:1265571509
Name:D'AGOSTINO, CARL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:JOSEPH
Last Name:D'AGOSTINO
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 1:2407 W LOUISIANA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5807
Mailing Address - Country:US
Mailing Address - Phone:432-620-8888
Mailing Address - Fax:432-620-8187
Practice Address - Street 1:2407 W LOUISIANA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5807
Practice Address - Country:US
Practice Address - Phone:432-620-8888
Practice Address - Fax:432-620-8187
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7460207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5541135OtherAETNA
TX0050EAOtherBLUE CROSS BLUE SHIELD
TX5541135OtherAETNA
TX00958JMedicare ID - Type Unspecified