Healthcare Provider Details

I. General information

NPI: 1053641746
Provider Name (Legal Business Name): RICHARD CARREGAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13737 NOEL RD STE 1600
DALLAS TX
75240-1374
US

IV. Provider business mailing address

13737 NOEL RD STE 1600
DALLAS TX
75240-1374
US

V. Phone/Fax

Practice location:
  • Phone: 303-933-8270
  • Fax: 214-712-2002
Mailing address:
  • Phone: 303-933-8270
  • Fax: 214-712-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101017489
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS11545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: