Provider Demographics
NPI:1770578924
Name:CAREY, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:CAREY
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 1:12241 ACADEMY RD NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8051
Mailing Address - Country:US
Mailing Address - Phone:505-938-4214
Mailing Address - Fax:505-944-7720
Practice Address - Street 1:12241 ACADEMY RD NE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-8051
Practice Address - Country:US
Practice Address - Phone:505-938-4214
Practice Address - Fax:505-944-7720
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020450207N00000X, 207NS0135X
NMMD2002-0450207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76659755Medicaid
NMNM009L30OtherBCBS
P00177449OtherMC RR
H81078Medicare UPIN
342418100Medicare ID - Type Unspecified