Provider Demographics
NPI:1245264183
Name:CARR, GARY D (MD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:CARR
Suffix:
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:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439
Mailing Address - Country:US
Mailing Address - Phone:618-943-2609
Mailing Address - Fax:618-943-6409
Practice Address - Street 1:11020 STATE ROUTE 250
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-3379
Practice Address - Country:US
Practice Address - Phone:618-943-2609
Practice Address - Fax:618-943-6409
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058645207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL003230OtherHEALTH ALLIANCE INS
IL5132004OtherBCBS
1729885OtherFIRST HEALTH
IL376006178007Medicaid
IL036058645Medicaid
838915OtherUNITED HEALTHCARE
IL131890OtherHEALTHLINK INS
IL131890OtherHEALTHLINK INS
IL376006178007Medicaid