Provider Demographics
NPI:1427138643
Name:CARR, PANNELL L (MD)
Entity type:Individual
Prefix:
First Name:PANNELL
Middle Name:L
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 LAMONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4560
Mailing Address - Country:US
Mailing Address - Phone:858-270-7633
Mailing Address - Fax:858-270-7692
Practice Address - Street 1:4440 LAMONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4560
Practice Address - Country:US
Practice Address - Phone:858-272-0022
Practice Address - Fax:858-272-7460
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF12200Medicare UPIN