Provider Demographics
NPI:1902881980
Name:WESTBROOK, CARL URBAN II (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:URBAN
Last Name:WESTBROOK
Suffix:II
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 1:1324 SOUTH BECKHAM
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3050
Mailing Address - Country:US
Mailing Address - Phone:903-597-7070
Mailing Address - Fax:903-597-7068
Practice Address - Street 1:1324 S BECKHAM AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3322
Practice Address - Country:US
Practice Address - Phone:903-597-7070
Practice Address - Fax:903-597-7068
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0376207V00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128201407Medicaid
TX128201407Medicaid
TX00G101Medicare PIN