Provider Demographics
NPI:1154351427
Name:QUAN, CAROLYN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:QUAN
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 1:3600 GASTON AVE
Mailing Address - Street 2:#550
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1904
Mailing Address - Country:US
Mailing Address - Phone:214-821-1177
Mailing Address - Fax:214-821-1193
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:#550
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1904
Practice Address - Country:US
Practice Address - Phone:214-821-1177
Practice Address - Fax:214-821-1193
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6674208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84238SOtherBCBS
G12156Medicare UPIN
TX84238SOtherBCBS