Healthcare Provider Details

I. General information

NPI: 1518927557
Provider Name (Legal Business Name): ALBERT CARL HENRY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N HALL ST STE 108
DALLAS TX
75226-1321
US

IV. Provider business mailing address

3214 BEVERLY DR
DALLAS TX
75205-2925
US

V. Phone/Fax

Practice location:
  • Phone: 214-236-5421
  • Fax:
Mailing address:
  • Phone: 214-236-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberE2610
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: