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General NPI Number Information
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NPI Number | 1568438984
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Entity Type | Individual
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Provider Name | CARL P FASTABEND MD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2006
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 1920 COUNTRY PLACE PKWY STE 110
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City | PEARLAND
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State | TX
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Zip | 77584-2282
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Country | US
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Telephone | 800-991-6117
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 NORTHDALE BLVD STE 201
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City | TAMPA
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State | FL
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Zip | 33624-1893
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Country | US
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Telephone | 800-991-6117
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Fax | 713-640-5938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | U2699
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | U2699
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License Number State | TX
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