Provider Demographics
NPI:1376201582
Name:CARSTARPHEN, TOMMY LEE JR (CPT)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:LEE
Last Name:CARSTARPHEN
Suffix:JR
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 JONAS SALK DR APT 318
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7435
Mailing Address - Country:US
Mailing Address - Phone:813-447-3738
Mailing Address - Fax:
Practice Address - Street 1:9920 JONAS SALK DR APT 318
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7435
Practice Address - Country:US
Practice Address - Phone:813-447-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-9192202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology