Provider Demographics
NPI:1295750149
Name:UNDERHILL, CARLA S (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3200 RED RIVER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2660
Mailing Address - Country:US
Mailing Address - Phone:512-472-3161
Mailing Address - Fax:512-476-4309
Practice Address - Street 1:3200 RED RIVER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2660
Practice Address - Country:US
Practice Address - Phone:512-472-3161
Practice Address - Fax:512-476-4309
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXTXG0224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123347001Medicaid
TX00JX84Medicare ID - Type Unspecified
TX123347001Medicaid