Provider Demographics
NPI:1194810341
Name:J J CARR MD PA
Entity type:Organization
Organization Name:J J CARR MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN-JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-767-0303
Mailing Address - Street 1:PO BOX 260097
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78426-0097
Mailing Address - Country:US
Mailing Address - Phone:361-767-0303
Mailing Address - Fax:361-761-0303
Practice Address - Street 1:13701 NORTHWEST BLVD
Practice Address - Street 2:SUITE B1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5114
Practice Address - Country:US
Practice Address - Phone:361-767-0303
Practice Address - Fax:361-761-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00970WMedicare PIN