Provider Demographics
NPI:1356326979
Name:VAN DE CARR, PHILIP PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:PAUL
Last Name:VAN DE CARR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3904 DELL RD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2610
Mailing Address - Country:US
Mailing Address - Phone:916-944-1079
Mailing Address - Fax:919-944-0115
Practice Address - Street 1:11000 OLSON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5653
Practice Address - Country:US
Practice Address - Phone:916-635-4120
Practice Address - Fax:916-635-7134
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG031151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44667Medicare UPIN