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Individual

CARLOS DE LA GARZA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2412 WILKINS DR, SANFORD, NC 27330-7268
(919) 776-6000
(919) 776-0130
Mailing address
330 SEVEN SPRINGS WAY, ATTN: PROVIDER ENROLLMENT, BRENTWOOD, TN 37027-5098
(615) 920-7000
(615) 920-8775

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
28019
NC
207Q00000X
Family Medicine Physician
Primary
8428019
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1225017122
NC
Enumeration date
01/10/2006
Last updated
05/11/2018
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