MEDICARE: DR. ROSS CARMICHAEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E8380	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CJ285	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1285696872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS CARMICHAEL MD

Provider Business Mailing Address
First Line	:	P.O. BOX 22000
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-7200
Country	:	US
Telephone Number	:	325-658-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 COLLEGE HILLS BLVD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6506
Country	:	US
Telephone Number	:	325-942-2611
Fax Number	:	325-942-6686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	09/30/2010

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