| Doctor Name: | DR. TED L CARELOCK |
| NPI Number: | 1972502367 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | D3992 |
| Business Practice Address: | 815 Pennsylvania Ave Fort Worth, TX - 761042224 |
| Business Phone Number: | 8173210312 |
| Business Fax Number: | 8173177033 |
| Mailing Address: | 816 W Cannon St, FORT WORTH |
| State: | TX |
| Postal Code: | 761043146 |
| Phone Number: | 8173210312 |
| Fax Number: | 8173177033 |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 08/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | D3992 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |