Provider Demographics
NPI:1124070909
Name:CARR, CHRISTIAN L (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:L
Last Name:CARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 420
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3559
Mailing Address - Country:US
Mailing Address - Phone:817-566-9361
Mailing Address - Fax:817-422-0858
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 420
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-566-9361
Practice Address - Fax:817-422-0858
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3601208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156615002Medicaid
TX156615001Medicaid
TXP01114352OtherRAILROAD MEDICARE
TXTXB166554Medicare PIN
TX156615002Medicaid
TX156615002Medicaid