MEDICARE: CARLOS B EVERETT, M.D.

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376620781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS B EVERETT, M.D.

Provider Business Mailing Address
First Line	:	917 S PORT AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-2301
Country	:	US
Telephone Number	:	361-887-0584
Fax Number	:	361-887-0586

Provider Business Practice Location Address
First Line	:	917 S PORT AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-2301
Country	:	US
Telephone Number	:	361-887-0584
Fax Number	:	361-887-0586

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARLOS B EVERETT
Credential	:	M.D.
Telephone Number	:	361-887-0584

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/29/2009

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