Provider Demographics
NPI:1184687394
Name:CAROTHERS, ARNOLD KEEFE (DO)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:KEEFE
Last Name:CAROTHERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 MEMORIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-7001
Mailing Address - Country:US
Mailing Address - Phone:409-237-6480
Mailing Address - Fax:
Practice Address - Street 1:8555 MEMORIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-7001
Practice Address - Country:US
Practice Address - Phone:409-237-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184075301Medicaid
TX00X118Medicare PIN
TX184075301Medicaid