Provider Demographics
NPI:1194145607
Name:CARMICAL, JIM (MD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:CARMICAL
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 1:940 OLD WARREN RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-9717
Mailing Address - Country:US
Mailing Address - Phone:870-224-4411
Mailing Address - Fax:817-702-1697
Practice Address - Street 1:940 OLD WARREN RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9717
Practice Address - Country:US
Practice Address - Phone:870-224-4411
Practice Address - Fax:870-224-0925
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8846207P00000X
ARE-10738207P00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program