Healthcare Provider Details

I. General information

NPI: 1174778302
Provider Name (Legal Business Name): MR. HAROLD DON CARPENTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 AIRWAY BLVD #D4
EL PASO TX
79925-3647
US

IV. Provider business mailing address

1201 AIRWAY BLVD #D4
EL PASO TX
79925-3647
US

V. Phone/Fax

Practice location:
  • Phone: 915-779-6200
  • Fax:
Mailing address:
  • Phone: 915-779-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50399
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: