Provider Demographics
NPI:1346430527
Name:CARMACK, ADRIENNE J K (MD)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:J K
Last Name:CARMACK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 731218
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1218
Mailing Address - Country:US
Mailing Address - Phone:903-315-4119
Mailing Address - Fax:903-315-4129
Practice Address - Street 1:703 E MARSHALL AVE
Practice Address - Street 2:SUITE 5007
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-315-4455
Practice Address - Fax:903-315-2466
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2015-07-23
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Provider Licenses
StateLicense IDTaxonomies
TXN1275208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology