Provider Demographics
NPI:1962568642
Name:RIZO-PATRON, CARLOS (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:RIZO-PATRON
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 1:4802 N LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3025
Mailing Address - Country:US
Mailing Address - Phone:806-788-0040
Mailing Address - Fax:806-788-0015
Practice Address - Street 1:4642 N LOOP 289
Practice Address - Street 2:STE. 215
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2409
Practice Address - Country:US
Practice Address - Phone:806-222-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9303207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122568103OtherFIRSTCARE
TX117053205Medicaid
TXP01112494OtherRAILROAD MEDICARE
NMR9909Medicaid
TX8DL701OtherBCBS
TXG39887Medicare UPIN
NMR9909Medicaid