MEDICARE: DR. JOHN THOMAS CARLO 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	2083P0901X	Public Health & General Preventive Medicine Physician	L9641	TX

General Provider Information

NPI Number	:	1578585386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN THOMAS CARLO M.D

Provider Business Mailing Address
First Line	:	3900 JUNIUS ST STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1602
Country	:	US
Telephone Number	:	214-521-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 WORTH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1607
Country	:	US
Telephone Number	:	214-521-5191
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/02/2022

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