1952301699 NPI number — THOMAS J CARPENTER DO

Table of content: THOMAS J CARPENTER DO (NPI 1952301699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952301699 NPI number — THOMAS J CARPENTER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
THOMAS
Provider Middle Name:
J
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:
1952301699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8250 BRYAN DAIRY RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33777-1353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-544-2500
Provider Business Mailing Address Fax Number:
727-541-6165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8250 BRYAN DAIRY RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33777-1353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-544-2500
Provider Business Practice Location Address Fax Number:
727-541-6165
Provider Enumeration Date:
07/22/2005

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: 207Q00000X , with the licence number:  32833 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 32833 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002056700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134M1CA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 075297500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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