Healthcare Provider Details

I. General information

NPI: 1972564037
Provider Name (Legal Business Name): PAUL A CARMICHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 E TUOLUMNE RD SUITE 201
TURLOCK CA
95382-1548
US

IV. Provider business mailing address

880 E TUOLUMNE RD SUITE 201
TURLOCK CA
95382-1548
US

V. Phone/Fax

Practice location:
  • Phone: 209-664-5070
  • Fax: 209-664-5077
Mailing address:
  • Phone: 209-664-5070
  • Fax: 209-664-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG87315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: