Provider Demographics
NPI:1568577211
Name:CARPENTIER, BRADLEY W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:W
Last Name:CARPENTIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2025
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-6125
Mailing Address - Country:US
Mailing Address - Phone:254-300-8339
Mailing Address - Fax:844-214-2393
Practice Address - Street 1:716 INDIAN TRL
Practice Address - Street 2:STE 120
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5702
Practice Address - Country:US
Practice Address - Phone:254-300-8339
Practice Address - Fax:844-214-2393
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1913207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370577YS47Medicare PIN