Provider Demographics
NPI:1427067958
Name:CARPENTER, RICHARD M (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:CARPENTER
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 1:30809 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4074
Mailing Address - Country:US
Mailing Address - Phone:253-839-2030
Mailing Address - Fax:253-839-1071
Practice Address - Street 1:30809 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4074
Practice Address - Country:US
Practice Address - Phone:253-839-2030
Practice Address - Fax:253-839-1071
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0199176OtherSTATE L&I
WA8906588OtherSTATE CRIME VICTIMS
WAP00244072OtherMEDICARE RAILROAD
WA1689702Medicaid
WAP00244072OtherMEDICARE RAILROAD
AB08495Medicare ID - Type Unspecified
WA1689702Medicaid