Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC007231 | PA |
Y | 222Z00000X | Podiatrist | SC007231 | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC007231 | PA |
NPI | 1003302068 |
---|---|
Provider Name | Dr. Jacob Carmichael |
First Address | Altoona, PA 16602-6247 |
Second Address | Altoona, PA 16602-6247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2018 |
Last Update Date | 01/12/2021 |