Provider Demographics
NPI:1356343040
Name:CARPENTER, ROBERT JAY III (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:CARPENTER
Suffix:III
Gender:M
Credentials:DO
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Mailing Address - Street 1:4051 BARRANCAS AVE
Mailing Address - Street 2:SUITE G, PMB 219
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3492
Mailing Address - Country:US
Mailing Address - Phone:850-723-9068
Mailing Address - Fax:888-217-1652
Practice Address - Street 1:4051 BARRANCAS AVE
Practice Address - Street 2:SUITE G, PMB 219
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-3492
Practice Address - Country:US
Practice Address - Phone:850-723-9068
Practice Address - Fax:888-217-1652
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2015-02-18
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Provider Licenses
StateLicense IDTaxonomies
CA20A 10964207RI0200X
FLOS13142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN