Provider Demographics
NPI:1336235480
Name:CARNER, DAVID VANCE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:VANCE
Last Name:CARNER
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 1:1036 D A BIGLANE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2331
Mailing Address - Country:US
Mailing Address - Phone:601-835-1182
Mailing Address - Fax:601-835-1546
Practice Address - Street 1:1036 D A BIGLANE DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2331
Practice Address - Country:US
Practice Address - Phone:601-835-1182
Practice Address - Fax:601-835-1546
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018182Medicaid
MS00018182Medicaid
MS021948314Medicare PIN