Basic Information
| Provider Information | |||||||||
| NPI: | 1194144246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLTON | ||||||||
| FirstName: | KISH | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 US HIGHWAY 271 N | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756864289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039465442 | ||||||||
| FaxNumber: | 9039465258 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 US HIGHWAY 271 N | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756864289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039465442 | ||||||||
| FaxNumber: | 9039465258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 12/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R4948 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.