Provider Demographics
NPI:1174543540
Name:CARPER, JOHN KIRKENDALL (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KIRKENDALL
Last Name:CARPER
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Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2433 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6562
Mailing Address - Country:US
Mailing Address - Phone:510-521-2300
Mailing Address - Fax:510-521-7947
Practice Address - Street 1:2433 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6562
Practice Address - Country:US
Practice Address - Phone:510-521-2300
Practice Address - Fax:510-521-7947
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG63665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE25097Medicare UPIN