Individual
CARLOS ALFREDO MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8501 WADE BLVD, BLDG. X, SUITE 1020, FRISCO, TX 75034-5894
(972) 668-5864
(972) 668-5825
Mailing address
8501 WADE BLVD, BLDG. X, SUITE 1020, FRISCO, TX 75034-5894
(972) 668-5864
(972) 668-5825
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
L8430
TX
2080P0214X
Pediatric Pulmonology Physician
Primary
L8430
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168602401
—
TX
05
—
168602402
—
TX
01
—
8U3552
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/13/2006
Last updated
01/21/2016
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