Healthcare Provider Details

I. General information

NPI: 1063407203
Provider Name (Legal Business Name): ROBERT JOHN CARNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 MCDONALD RD STE 100
TYLER TX
75701-5934
US

IV. Provider business mailing address

2608 MCDONALD RD STE 100
TYLER TX
75701-5934
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-5514
  • Fax:
Mailing address:
  • Phone: 903-595-5514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH1563
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberH1563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: