Healthcare Provider Details

I. General information

NPI: 1689669111
Provider Name (Legal Business Name): CARL F PAINTER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TRACY PAINTER III MD

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14017 JAMESTOWN RD
BREESE IL
62230-3647
US

IV. Provider business mailing address

14017 JAMESTOWN RD
BREESE IL
62230-3647
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-7154
  • Fax: 618-526-8248
Mailing address:
  • Phone: 618-526-7154
  • Fax: 618-526-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number21533
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036101536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: