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General NPI Number Information
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NPI Number | 1790961167
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Entity Type | Organization
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Legal Business Name | CARNETT CLINIC, LLC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 4990 E MEDITERRANEAN DR STE A
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2495
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Country | US
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Telephone | 520-439-5186
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Fax | 520-439-4466
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Provider Business Mailing Address
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Address Line | 4990 E MEDITERRANEAN DR STE A
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2495
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Country | US
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Telephone | 520-439-5186
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Fax | 520-439-4466
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARK CHRISTIAN CARNETT
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Credential | D.O.
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Telephone | 520-439-5186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 3174
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License Number State | AZ
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