Provider Demographics
NPI:1790988947
Name:CARR, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:CARR
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 1:371 S BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5761
Mailing Address - Country:US
Mailing Address - Phone:573-331-6710
Mailing Address - Fax:573-331-6710
Practice Address - Street 1:371 S BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5761
Practice Address - Country:US
Practice Address - Phone:573-331-6710
Practice Address - Fax:573-331-6710
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431654207R00000X
MO2012016488207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2755933Medicaid
PA1019255070001Medicaid
PA111676NJKMedicare PIN
PAP00466745Medicare PIN
PAP00475909Medicare PIN
PA1019255070001Medicaid