Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1739 | TX |
Y | 222Z00000X | Podiatrist | 1739 | TX |
NPI | 1043212889 |
---|---|
Provider Name | David L Carmack |
First Address | Burnet, TX 78611-7219 |
Second Address | Burnet, TX 78611-4537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 24/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V05633 | (02) | TX |