Provider Demographics
NPI:1346298031
Name:CARPENTER, BRUCE D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:409 GLENWOOD ST
Mailing Address - Street 2:500
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4933
Mailing Address - Country:US
Mailing Address - Phone:254-897-2202
Mailing Address - Fax:254-897-1638
Practice Address - Street 1:2800 VILLAGE RD
Practice Address - Street 2:108
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-4193
Practice Address - Country:US
Practice Address - Phone:817-573-0444
Practice Address - Fax:817-573-2733
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF6508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130769611Medicaid
TX191011901Medicaid
TX00X771Medicare PIN
TX191011901Medicaid
TX130769611Medicaid