MEDICARE: DR. ROBERT JAY CARPENTER III D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	20A 10964	CA
2	207R00000X	Internal Medicine Physician	OS13142	FL

General Provider Information

NPI Number	:	1356343040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JAY CARPENTER III D.O.

Provider Business Mailing Address
First Line	:	4051 BARRANCAS AVE
Second Line	:	SUITE G, PMB 219
City	:	PENSACOLA
State	:	FL
Zip	:	32507-3492
Country	:	US
Telephone Number	:	850-723-9068
Fax Number	:	888-217-1652

Provider Business Practice Location Address
First Line	:	4051 BARRANCAS AVE
Second Line	:	SUITE G, PMB 219
City	:	PENSACOLA
State	:	FL
Zip	:	32507-3492
Country	:	US
Telephone Number	:	850-723-9068
Fax Number	:	888-217-1652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/18/2015

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