Individual
DR. TED L CARELOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0312
(817) 317-7033
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0312
(817) 317-7033
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
D3992
TX
2085R0202X
Diagnostic Radiology Physician
Primary
D3992
TX
2085U0001X
Diagnostic Ultrasound Physician
D3992
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1341299-11
—
TX
05
—
134129906
—
TX
05
—
134129909
—
TX
Enumeration date
07/18/2005
Last updated
08/15/2012
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