Healthcare Provider Details

I. General information

NPI: 1225633738
Provider Name (Legal Business Name): EUGENE CARPENTER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 FLOWER ST
BAKERSFIELD CA
93305-4144
US

IV. Provider business mailing address

540 LA MIRADA AVE
SAN MARINO CA
91108-1661
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8001
  • Fax:
Mailing address:
  • Phone: 626-622-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberG25507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: