Healthcare Provider Details

I. General information

NPI: 1992749832
Provider Name (Legal Business Name): BRIAN J CARMACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARY STREET
EVANSVILLE IN
47747-0001
US

IV. Provider business mailing address

PO BOX 3407
EVANSVILLE IN
47733-3407
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-6800
  • Fax: 812-450-6822
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01058756A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: