Healthcare Provider Details

I. General information

NPI: 1285745695
Provider Name (Legal Business Name): ALFRED NATHAN CARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 MOUNTAIN VIEW AVE
LONGMONT CO
80501-3211
US

IV. Provider business mailing address

2030 MOUNTAIN VIEW AVE STE 500
LONGMONT CO
80501-3183
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-3204
  • Fax:
Mailing address:
  • Phone: 303-772-3204
  • Fax: 303-772-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number15802
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: