Healthcare Provider Details

I. General information

NPI: 1497737308
Provider Name (Legal Business Name): EDWARD S CARMICK JR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 WHEATON WAY # 204
BREMERTON WA
98310-3305
US

IV. Provider business mailing address

2528 WHEATON WAY # 204
BREMERTON WA
98310-3305
US

V. Phone/Fax

Practice location:
  • Phone: 360-478-0522
  • Fax: 360-479-0225
Mailing address:
  • Phone: 360-478-0522
  • Fax: 360-479-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number00010274
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number00010274
License Number StateWA

VIII. Authorized Official

Name: DR. EDWARD S CARMICK
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 360-478-0522