Provider Demographics
NPI:1710320577
Name:CARPENTER, JAMES LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LOUIS
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 1:205 N 5TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1877
Mailing Address - Country:US
Mailing Address - Phone:314-616-7321
Mailing Address - Fax:636-724-3896
Practice Address - Street 1:205 N 5TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1877
Practice Address - Country:US
Practice Address - Phone:314-616-7321
Practice Address - Fax:636-724-3896
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO29539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist