Provider Demographics
NPI:1114968468
Name:CARPENTER, JAMES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:645 MCQUEEN SMITH RD N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7268
Mailing Address - Country:US
Mailing Address - Phone:334-365-5987
Mailing Address - Fax:334-365-5315
Practice Address - Street 1:645 MCQUEEN SMITH RD N
Practice Address - Street 2:SUITE 101
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7268
Practice Address - Country:US
Practice Address - Phone:334-365-5987
Practice Address - Fax:334-365-5315
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL14134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000082242Medicaid
AL000082242Medicaid
ALC72072Medicare UPIN