Individual
CARLTON D PITTARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1280 S MAIN ST STE 106, GRAPEVINE, TX 76051-7509
(817) 310-0014
(817) 416-4659
Mailing address
1280 S MAIN ST STE 106, GRAPEVINE, TX 76051-7509
(817) 310-0014
(817) 416-4659
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
C6476
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102579304
—
TX
05
—
102579305
—
TX
Enumeration date
07/14/2006
Last updated
04/22/2010
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