Individual
DR. CARLOS G FASOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1411 N BECKLEY AVE, PAV III STE#268, DALLAS, TX 75203-1259
(214) 947-4400
(214) 947-4404
Mailing address
1411 N BECKLEY AVE, PAV III STE#268, DALLAS, TX 75203-1259
(214) 947-4400
(214) 947-4404
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
K7283
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040635703
—
TX
05
—
040635704
—
TX
01
—
8DL222
BLUE CROSS
TX
Enumeration date
12/10/2007
Last updated
12/04/2012
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