MEDICARE: DR. CARLOS L. VENEGAS 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	174400000X	Specialist	K0566	TX

General Provider Information

NPI Number	:	1558385252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS L. VENEGAS M.D.

Provider Business Mailing Address
First Line	:	8222 DOUGLAS AVE
Second Line	:	SUITE 601
City	:	DALLAS
State	:	TX
Zip	:	75225-5923
Country	:	US
Telephone Number	:	214-363-5400
Fax Number	:	214-363-5411

Provider Business Practice Location Address
First Line	:	8222 DOUGLAS AVE
Second Line	:	SUITE 601
City	:	DALLAS
State	:	TX
Zip	:	75225-5923
Country	:	US
Telephone Number	:	214-363-5400
Fax Number	:	214-363-5411

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/15/2014

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