Provider Demographics
NPI:1730246018
Name:TOLEDO, LUIZ CARLOS (MD)
Entity type:Individual
Prefix:
First Name:LUIZ
Middle Name:CARLOS
Last Name:TOLEDO
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 1:4255 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4233
Mailing Address - Country:US
Mailing Address - Phone:817-377-0050
Mailing Address - Fax:817-377-0054
Practice Address - Street 1:4255 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4233
Practice Address - Country:US
Practice Address - Phone:817-377-0050
Practice Address - Fax:817-377-0054
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8763207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00064431Medicaid
TXTXB140045Medicare PIN
TXP00064431Medicaid