Individual
CAROLYN BANGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6296 E GRANT RD STE 180, TUCSON, AZ 85712-5832
(520) 290-8555
(520) 290-6470
Mailing address
PO BOX 201088, HOUSTON, TX 77216-1088
(713) 500-3500
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M4704
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186297102
—
TX
01
—
8G7805
BCBSTX
TX
Enumeration date
11/01/2006
Last updated
09/07/2021
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