Provider Demographics
NPI:1396033072
Name:CARPENTER, DUSTIN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:CHARLES
Last Name:CARPENTER
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 1:909 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TARKIO
Mailing Address - State:MO
Mailing Address - Zip Code:64491-1119
Mailing Address - Country:US
Mailing Address - Phone:816-309-8028
Mailing Address - Fax:
Practice Address - Street 1:514 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-1145
Practice Address - Country:US
Practice Address - Phone:660-686-2329
Practice Address - Fax:660-686-2799
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine