Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD00032013 | WA |
NPI | 1205906294 |
---|---|
Provider Name | Dr. Clyde T. Carpenter |
First Address | Olympia, WA 98507-0368 |
Second Address | Olympia, WA 98502-8654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 23/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8209587 | (05) | WA |
G52454 | (02) | WA |