Provider Demographics
NPI:1013989078
Name:CARPENTER, CATHY P (MD)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:P
Last Name:CARPENTER
Suffix:
Gender:F
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-616-1442
Practice Address - Street 1:1707 W SAINT MARYS RD STE 175
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2613
Practice Address - Country:US
Practice Address - Phone:520-616-6790
Practice Address - Fax:520-622-0849
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA136324OtherHEALTH AMERICA
PA606644OtherHIGHMARK BLUE SHIELD
PA0009585560005Medicaid
PA1520948OtherGATEWAY HEALTH PLAN
PA02377500OtherCAPITAL BLUE CROSS
PA092769PL6Medicare ID - Type UnspecifiedMEDICARE
PA0009585560005Medicaid