Provider Demographics
NPI:1497737308
Name:EDWARD S CARMICK JR MD
Entity Type:Organization
Organization Name:EDWARD S CARMICK JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-478-0522
Mailing Address - Street 1:2528 WHEATON WAY
Mailing Address - Street 2:# 204
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3305
Mailing Address - Country:US
Mailing Address - Phone:360-478-0522
Mailing Address - Fax:360-479-0225
Practice Address - Street 1:2528 WHEATON WAY
Practice Address - Street 2:# 204
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3305
Practice Address - Country:US
Practice Address - Phone:360-478-0522
Practice Address - Fax:360-479-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010274207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1092519Medicaid
WA81892OtherLABOR & INDUSTRIES
WA81892OtherLABOR & INDUSTRIES