Provider Demographics
NPI:1063596997
Name:CARLL, KENDALL EDWARD II (MD)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:EDWARD
Last Name:CARLL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 INDEPENDENCE PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4013
Mailing Address - Country:US
Mailing Address - Phone:469-998-2273
Mailing Address - Fax:469-998-2272
Practice Address - Street 1:8080 INDEPENDENCE PKWY STE 230
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025
Practice Address - Country:US
Practice Address - Phone:469-998-2273
Practice Address - Fax:469-998-2272
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN6843207X00000X
TXM8573207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BW305OtherBCBS PIN
TXP00697462OtherRAIL ROAD MEDICARE
TX209272801Medicaid
TXTXB11427Medicare PIN
TX8BW305OtherBCBS PIN