Provider Demographics
NPI:1063407203
Name:CARNEY, ROBERT JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:CARNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 MCDONALD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5934
Mailing Address - Country:US
Mailing Address - Phone:903-595-5514
Mailing Address - Fax:
Practice Address - Street 1:2608 MCDONALD RD
Practice Address - Street 2:STE 100
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5934
Practice Address - Country:US
Practice Address - Phone:903-595-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1563207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452105OtherAETNA
TX89427JOtherBCBS OF TEXAS
P1578565OtherOXFORD HEALTH PLANS
TX038899308OtherUNITED HEALTHCARE
TX128691601Medicaid
TX452105OtherAETNA
C14211Medicare UPIN
TX060048906Medicare PIN