Provider Demographics
NPI:1972564037
Name:CARMICHAEL, PAUL A (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:CARMICHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:880 E TUOLUMNE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1548
Mailing Address - Country:US
Mailing Address - Phone:209-664-5070
Mailing Address - Fax:209-664-5077
Practice Address - Street 1:880 E TUOLUMNE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1548
Practice Address - Country:US
Practice Address - Phone:209-664-5070
Practice Address - Fax:209-664-5077
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87315208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG873150Medicaid
B05063Medicare UPIN
CA00G873150Medicare PIN