Healthcare Provider Details

I. General information

NPI: 1881232072
Provider Name (Legal Business Name): CARL AUSTIN LOBITZ MDS, RDN, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 11/12/2023
Certification Date: 11/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 ROMERIA DR
DURHAM NC
27713-2070
US

IV. Provider business mailing address

850 ROMERIA DR
DURHAM NC
27713-2070
US

V. Phone/Fax

Practice location:
  • Phone: 210-618-2210
  • Fax:
Mailing address:
  • Phone: 210-618-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberDT86028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: