Provider Demographics
NPI:1902887755
Name:MCDOUGALD, CAROLYN BARKER (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BARKER
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 S COOPER ST STE 131-245
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5866
Mailing Address - Country:US
Mailing Address - Phone:832-266-3554
Mailing Address - Fax:
Practice Address - Street 1:3401 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1734
Practice Address - Country:US
Practice Address - Phone:806-763-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2458207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169246901Medicaid
TXI05247Medicare UPIN
TX00609WMedicare ID - Type Unspecified