Provider Demographics
NPI:1750566048
Name:MIDDLETON, CARL P (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:P
Last Name:MIDDLETON
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 1:323 WESTPARK WAY
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3902
Mailing Address - Country:US
Mailing Address - Phone:866-202-1032
Mailing Address - Fax:214-570-5631
Practice Address - Street 1:323 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3902
Practice Address - Country:US
Practice Address - Phone:866-202-1032
Practice Address - Fax:214-570-5631
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0978208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197324003Medicaid
TX197324005Medicaid
TX75-2966610OtherTAX IDENTIFICATION NUMBER
TX156122701Medicaid
TX197324004Medicaid
TX8L3023Medicare PIN
TX75-2966610OtherTAX IDENTIFICATION NUMBER
TX156122701Medicaid
TX197324005Medicaid
TXTXB104232Medicare PIN