Healthcare Provider Details

I. General information

NPI: 1770694044
Provider Name (Legal Business Name): HARRY B CARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MARK WEST SPRINGS RD FL 2
SANTA ROSA CA
95403-1766
US

IV. Provider business mailing address

PO BOX 512
GRATON CA
95444-0512
US

V. Phone/Fax

Practice location:
  • Phone: 707-694-8277
  • Fax:
Mailing address:
  • Phone: 707-694-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberG65092
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG65092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: