Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | J2172 | TX |
NPI | 1063476877 |
---|---|
Provider Name | Dr. Carlos L Macias |
First Address | Fort Worth, TX 76104-3903 |
Second Address | Fort Worth, TX 76104-3903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 01/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105424901 | (05) | TX |
8HT407 | BCBSTX (01) | TX |
G66187 | (02) | TX |