Provider Demographics
NPI:1376594804
Name:PAUL, CAREY (MD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:
Last Name:PAUL
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:PO BOX 10488
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0488
Mailing Address - Country:US
Mailing Address - Phone:888-344-9111
Mailing Address - Fax:909-335-7130
Practice Address - Street 1:7291 BOULDER AVE STE 2C
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-6900
Practice Address - Country:US
Practice Address - Phone:909-862-4226
Practice Address - Fax:909-862-0319
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ43231ZOtherBLUE SHIELD OF CA
CA1700836475OtherGRP NPI
CA1700836475OtherGRP NPI
CAZZZ43231ZOtherBLUE SHIELD OF CA
CA080057696Medicare PIN
CA00C429930Medicare ID - Type Unspecified