Healthcare Provider Details

I. General information

NPI: 1710107131
Provider Name (Legal Business Name): MR. CHARLES TOBY CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MRS. JULIE KAY CARR

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19064 W 61ST PL
GOLDEN CO
80403-1031
US

IV. Provider business mailing address

19064 W 61ST PL
GOLDEN CO
80403-1031
US

V. Phone/Fax

Practice location:
  • Phone: 303-279-7077
  • Fax: 303-279-1012
Mailing address:
  • Phone: 303-279-7977
  • Fax: 303-279-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: