MEDICARE: CARREL DUTRA ANANFAH BAKOUA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		NM

General Provider Information

NPI Number	:	1194660597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARREL DUTRA ANANFAH BAKOUA DO

Provider Business Mailing Address
First Line	:	2000 MEGAN CREEK DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5038
Country	:	US
Telephone Number	:	214-605-6081
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 SAMARITAN DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1170
Country	:	US
Telephone Number	:	575-800-3181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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