Provider Demographics
NPI:1841250503
Name:CARR, DAVID L (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:CARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SEMINOLE RD
Mailing Address - Street 2:STE 207
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3743
Mailing Address - Country:US
Mailing Address - Phone:231-739-7238
Mailing Address - Fax:
Practice Address - Street 1:433 SEMINOLE RD
Practice Address - Street 2:STE 207
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3743
Practice Address - Country:US
Practice Address - Phone:231-739-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000537213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480058464OtherMEDICARE DME
480058464OtherRAILROAD MEDICARE
T99194Medicare UPIN
480058464OtherMEDICARE DME
4814360001Medicare NSC