Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2016018274 | MO |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2016018274 | MO |
NPI | 1124432430 |
---|---|
Provider Name | Dr. Wesley William Carr |
First Address | Jbsa Lackland, TX 78236-5638 |
Second Address | Jbsa Lackland, TX 78236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 15/08/2018 |