MEDICARE: MRS. CARRIE ANN STOGNER L.A.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	AT1221	TX

General Provider Information

NPI Number	:	1033329644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE ANN STOGNER L.A.T.

Provider Business Mailing Address
First Line	:	703 FARLEY ST
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-3823
Country	:	US
Telephone Number	:	979-543-4057
Fax Number	:	979-543-5565

Provider Business Practice Location Address
First Line	:	600 W NORRIS ST
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-2430
Country	:	US
Telephone Number	:	979-578-1934
Fax Number	:	979-543-5565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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