Provider Demographics
NPI:1346205754
Name:VEST, CARL E (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:VEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 S PROMENADE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9073
Mailing Address - Country:US
Mailing Address - Phone:479-616-1485
Mailing Address - Fax:479-239-0536
Practice Address - Street 1:2012 S PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9073
Practice Address - Country:US
Practice Address - Phone:479-616-1485
Practice Address - Fax:479-239-0536
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6126207Q00000X
ARE1496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132817001Medicaid
AR80184754Medicare PIN
AR57297Medicare PIN
AR132817001Medicaid
AR5K593Medicare PIN