Healthcare Provider Details

I. General information

NPI: 1245286137
Provider Name (Legal Business Name): DAVID R CARR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 103 SUPPLY STREET
GARY WV
24836
US

IV. Provider business mailing address

PO BOX 100
GARY WV
24836-0100
US

V. Phone/Fax

Practice location:
  • Phone: 304-448-2101
  • Fax: 304-448-3217
Mailing address:
  • Phone: 304-448-2101
  • Fax: 304-448-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number808
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: