Provider Demographics
NPI:1972920080
Name:CARL, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CARL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1524
Mailing Address - Country:US
Mailing Address - Phone:509-786-2222
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:BENTON CITY CLINIC-PROSSER MEMORIAL HEALTH
Practice Address - Street 2:701 DALE AVE SUITE A
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99350
Practice Address - Country:US
Practice Address - Phone:509-588-4075
Practice Address - Fax:509-588-4197
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60763667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics