Provider Demographics
NPI:1104908185
Name:CARRASCO, LONDA G (MD)
Entity type:Individual
Prefix:
First Name:LONDA
Middle Name:G
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 PORT LN STE 2
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2470
Mailing Address - Country:US
Mailing Address - Phone:806-359-9100
Mailing Address - Fax:806-359-7022
Practice Address - Street 1:1911 PORT LN STE 2
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2470
Practice Address - Country:US
Practice Address - Phone:806-359-9100
Practice Address - Fax:806-359-7022
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5083207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX848615OtherBCBS
TX5820089OtherAETNA
TX5820089OtherAETNA