Provider Demographics
NPI:1194820381
Name:CARREL, CHAD LEE (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:LEE
Last Name:CARREL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 N. OAKLAND
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613
Mailing Address - Country:US
Mailing Address - Phone:417-326-8700
Mailing Address - Fax:417-777-7881
Practice Address - Street 1:1551 N. OAKLAND
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-326-8700
Practice Address - Fax:417-777-7881
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004007602363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ17015Medicare UPIN