Provider Demographics
NPI:1598723603
Name:CARPENTER, PAUL L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5009
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD2519207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0017218OtherSD BCBS
MN538R6CAOtherMN BCBS - PLAN 538R2NO
MN91062CAOtherMN BCBS - PLAN 91057NO
SD2519OtherDAKOTACARE
IA1107466Medicaid
24679OtherHEALTH PARTNERS
IA53988OtherIA BCBS
MN168089OtherUCARE
SD6000840Medicaid
931451029031OtherPREFERRED ONE
IA1107466Medicaid
931451029031OtherPREFERRED ONE
24679OtherHEALTH PARTNERS