Provider Demographics
NPI:1285745695
Name:CARR, ALFRED NATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:NATHAN
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 1:2030 MOUNTAIN VIEW AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3183
Mailing Address - Country:US
Mailing Address - Phone:303-772-3204
Mailing Address - Fax:303-772-7043
Practice Address - Street 1:1750 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3211
Practice Address - Country:US
Practice Address - Phone:303-772-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15802207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01158021Medicaid
COD22921Medicare UPIN
CTCA16121Medicare ID - Type Unspecified