Provider Demographics
NPI:1831206408
Name:CARRIKER, MARY KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHLEEN
Last Name:CARRIKER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3125 N. 32ND STREET
Mailing Address - Street 2:100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6281
Mailing Address - Country:US
Mailing Address - Phone:602-956-7414
Mailing Address - Fax:602-957-3227
Practice Address - Street 1:3125 N 32ND ST
Practice Address - Street 2:100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6281
Practice Address - Country:US
Practice Address - Phone:602-956-7414
Practice Address - Fax:602-957-3227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AZ5301207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ248098Medicaid
AZ248098Medicaid