Provider Demographics
NPI:1174565089
Name:TABOADA, CARLOS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:TABOADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3705 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7753
Practice Address - Country:US
Practice Address - Phone:972-867-3577
Practice Address - Fax:972-985-9433
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7575207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7055OtherBLUE CROSS OF TEXAS
TX174440101Medicaid
TX174440103Medicaid
TXI35315Medicare UPIN
TX174440101Medicaid
TX174440103Medicaid
TX335828YKYCMedicare PIN
TX174440103Medicaid
TX174440101Medicaid