MEDICARE: CARROLLTON ANESTHESIA CONSULTANTS

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1407475916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLLTON ANESTHESIA CONSULTANTS

Provider Business Mailing Address
First Line	:	3330 EARHART DR STE 206
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-5041
Country	:	US
Telephone Number	:	972-991-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 EARHART DR STE 206
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-5041
Country	:	US
Telephone Number	:	972-991-9950
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GABRIEL RODRIGUEZ
Credential	:	MD
Telephone Number	:	972-991-9950

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	04/14/2020

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