Individual
CARLOS J MIJARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3455 LOCKE AVE STE 315, FORT WORTH, TX 76107
(817) 336-1189
(817) 877-5665
Mailing address
3455 LOCKE AVE STE 315, FORT WORTH, TX 76107-5745
(817) 336-1189
(817) 877-5665
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H5929
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073430302
—
TX
05
—
073430303
—
TX
Enumeration date
07/12/2006
Last updated
06/25/2018
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