Provider Demographics
NPI:1114281169
Name:CARR, GINA (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:ALKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81235-0999
Mailing Address - Country:US
Mailing Address - Phone:970-944-2331
Mailing Address - Fax:970-944-2320
Practice Address - Street 1:700 N. HENSON ST.
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:CO
Practice Address - Zip Code:81235-0999
Practice Address - Country:US
Practice Address - Phone:970-944-2331
Practice Address - Fax:970-944-2320
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125032207Q00000X
CO4465207Q00000X
CO53066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine