1629576079 NPI number — ERIC R KARR DO

Table of content: ERIC R KARR DO (NPI 1629576079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629576079 NPI number — ERIC R KARR DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARR
Provider First Name:
ERIC
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629576079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4881 SUGAR MAPLE DR
Provider Second Line Business Mailing Address:
INTERNAL MEDICINE CLINIC A
Provider Business Mailing Address City Name:
WRIGHT PATTERSON AFB
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-257-2432
Provider Business Mailing Address Fax Number:
937-696-3696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4881 SUGAR MAPLE DR
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE CLINIC A
Provider Business Practice Location Address City Name:
WRIGHT PATTERSON AFB
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45433-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-522-2778
Provider Business Practice Location Address Fax Number:
937-696-3696
Provider Enumeration Date:
01/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  34.014087 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0301669 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com