Provider Demographics
NPI:1447268479
Name:CAVAZOS, CAROLYN LEWALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:LEWALLEN
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9639 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3415
Mailing Address - Country:US
Mailing Address - Phone:210-692-3636
Mailing Address - Fax:210-692-3668
Practice Address - Street 1:9639 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3415
Practice Address - Country:US
Practice Address - Phone:210-692-3636
Practice Address - Fax:210-692-3668
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2084207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00SK31Medicare ID - Type Unspecified
B21746Medicare UPIN