Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R5096 | TX |
N | 207Q00000X | Family Doctor | BP10026779 | TX |
NPI | 1013126390 |
---|---|
Provider Name | Dr. Michael David Carletti |
First Address | Fort Worth, TX 76107-2553 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 04/04/2018 |