Provider Demographics
NPI:1972610392
Name:CARPENTER, PAUL ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:CARPENTER
Suffix:JR
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 1:12 NELSONCREST PL
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8065
Mailing Address - Country:US
Mailing Address - Phone:406-862-9610
Mailing Address - Fax:406-863-4655
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:MERCY MEDICAL CENTER - SOUIX CITY
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2046
Practice Address - Fax:712-279-5619
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA368082085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30BDJDZMedicare ID - Type Unspecified