Provider Demographics
NPI:1184060881
Name:CARPENTER, JAY DAVID (DO)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:DAVID
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1500
Mailing Address - Country:US
Mailing Address - Phone:865-677-6708
Mailing Address - Fax:
Practice Address - Street 1:2850 LEWIS LN STE 113
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9378
Practice Address - Country:US
Practice Address - Phone:903-706-5173
Practice Address - Fax:903-706-5176
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2826208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology