Healthcare Provider Details

I. General information

NPI: 1376596130
Provider Name (Legal Business Name): CARL G W DAHLBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/20/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLUMBUS MEDICAL CLINIC 2122 HWY 71 S
COLUMBUS TX
78934
US

IV. Provider business mailing address

DEPT 794 PO BOX 4346
HOUSTON TX
77210-4346
US

V. Phone/Fax

Practice location:
  • Phone: 979-732-2318
  • Fax: 979-732-2310
Mailing address:
  • Phone: 713-255-4000
  • Fax: 713-255-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberH3559
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberH3559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: