Healthcare Provider Details

I. General information

NPI: 1821077074
Provider Name (Legal Business Name): CARL D SOLOMON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 GASTON AVE SUITE 330
DALLAS TX
75246-1541
US

IV. Provider business mailing address

3801 GASTON AVE SUITE 330
DALLAS TX
75246-1541
US

V. Phone/Fax

Practice location:
  • Phone: 214-824-3851
  • Fax: 214-824-3852
Mailing address:
  • Phone: 214-824-3851
  • Fax: 214-824-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0411
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: