Provider Demographics
NPI:1306878723
Name:CARPENTER, WILLIAM M (MD PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 N CENTRAL EXPY STE 448
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2188
Mailing Address - Country:US
Mailing Address - Phone:214-827-8407
Mailing Address - Fax:214-827-5001
Practice Address - Street 1:4131 N CENTRAL EXPY STE 448
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2188
Practice Address - Country:US
Practice Address - Phone:214-827-8407
Practice Address - Fax:214-827-5001
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3302208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097954402Medicaid
TX097954402Medicaid
TX8936K0Medicare PIN