Provider Demographics
NPI:1396735122
Name:ISRAEL, CARL NOAH (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:NOAH
Last Name:ISRAEL
Suffix:
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 1:1783 TROUP HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5869
Mailing Address - Country:US
Mailing Address - Phone:903-595-2283
Mailing Address - Fax:903-595-1063
Practice Address - Street 1:1783 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5869
Practice Address - Country:US
Practice Address - Phone:903-595-2283
Practice Address - Fax:903-595-1063
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2396207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1775690Medicaid
TX115919601OtherSMITH COUNTY INDIGENT
TX115919601Medicaid
TX86K921OtherBCBS OF TEXAS
TX060002991OtherRAILROAD MEDICARE
LA1775690Medicaid
TX115919601Medicaid