Provider Demographics
NPI:1316264724
Name:BYNUM, CARL G (DO)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:BYNUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E JEANINE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3369
Mailing Address - Country:US
Mailing Address - Phone:573-230-1313
Mailing Address - Fax:
Practice Address - Street 1:1701 E JEANINE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3369
Practice Address - Country:US
Practice Address - Phone:573-230-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9129207Q00000X
AZ006156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine