Provider Demographics
NPI:1215927686
Name:CARPENTER, WAYNE LEROY II (PA)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:LEROY
Last Name:CARPENTER
Suffix:II
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:3851 ROGER BROOKE DR
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4501
Mailing Address - Country:US
Mailing Address - Phone:210-295-2460
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-295-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant