Provider Demographics
NPI:1093818635
Name:CARPENTER, DOUGLAS RAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RAY
Last Name:CARPENTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 LANTANA ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-1903
Mailing Address - Country:US
Mailing Address - Phone:931-484-5141
Mailing Address - Fax:931-484-5620
Practice Address - Street 1:100 LANTANA ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-1903
Practice Address - Country:US
Practice Address - Phone:931-484-5141
Practice Address - Fax:931-484-5620
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD17544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080059056OtherRAILROAD MEDICARE
TN3084713Medicaid
TN3072543OtherBLUE CROSS
080059056OtherRAILROAD MEDICARE
TN3072543OtherBLUE CROSS