Healthcare Provider Details

I. General information

NPI: 1477488666
Provider Name (Legal Business Name): CARLOS ANTONIO LINARES KOLOFFON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 4TH STREET STOP: 8143
LUBBOCK TX
79430-0001
US

IV. Provider business mailing address

4818 96TH ST
LUBBOCK TX
79424-4815
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-1083
  • Fax:
Mailing address:
  • Phone: 929-239-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10100582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: