Provider Demographics
NPI:1043212889
Name:CARMACK, DAVID L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:CARMACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 FM 1431 STE 105
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5006
Mailing Address - Country:US
Mailing Address - Phone:830-265-6104
Mailing Address - Fax:830-376-5074
Practice Address - Street 1:618 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5206
Practice Address - Country:US
Practice Address - Phone:830-265-6104
Practice Address - Fax:830-376-5074
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1739213E00000X, 261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043212889Medicaid
TX8K8627Medicare PIN
TXP00255236Medicare PIN
TX176596801Medicaid