Provider Demographics
NPI:1497245369
Name:CARPENTER, CHASE FARRIS (DO)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:FARRIS
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SVCS
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3293
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1350 CHESTER BLVD
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1963
Practice Address - Country:US
Practice Address - Phone:765-935-8914
Practice Address - Fax:765-935-8915
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005816A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine