Basic Information
Provider Information
NPI: 1891104550
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARLTON
FirstName: JOSHUA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 816 W CANNON ST
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761043146
CountryCode: US
TelephoneNumber: 8173210404
FaxNumber:  
Practice Location
Address1: 815 PENNSYLVANIA AVE
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761042224
CountryCode: US
TelephoneNumber: 8173210404
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/07/2014
LastUpdateDate: 03/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XQ9973TXY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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