Provider Demographics
NPI:1356402887
Name:CARNETT, MARK CHRISTIAN (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTIAN
Last Name:CARNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CALLE PORTAL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-439-5186
Mailing Address - Fax:520-439-4466
Practice Address - Street 1:155 CALLE PORTAL
Practice Address - Street 2:SUITE 600
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-439-5186
Practice Address - Fax:520-439-4466
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3174207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ362088004Medicaid
AZZ102182Medicare ID - Type Unspecified
AZ362088004Medicaid