Provider Demographics
NPI:1023056272
Name:CARPENTER, BILLY W (DO)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:W
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DO
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 679
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510
Mailing Address - Country:US
Mailing Address - Phone:325-893-4010
Mailing Address - Fax:325-893-4042
Practice Address - Street 1:1712 N ACCESS RD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510
Practice Address - Country:US
Practice Address - Phone:325-893-4010
Practice Address - Fax:325-893-4042
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V4760OtherBLUE CROSS BLUE SHIELD
TX8V4760OtherBLUE CROSS BLUE SHIELD