Provider Demographics
NPI:1275944399
Name:DEVEMARK, CARL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DAVID
Last Name:DEVEMARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10201 GATEWAY BLVD W STE 130
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7647
Mailing Address - Country:US
Mailing Address - Phone:915-594-1000
Mailing Address - Fax:915-594-1007
Practice Address - Street 1:10201 GATEWAY BLVD W STE 130
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7647
Practice Address - Country:US
Practice Address - Phone:915-594-1000
Practice Address - Fax:915-594-1007
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery