Basic Information
| Provider Information | |||||||||
| NPI: | 1023056272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | BILLY | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 679 | ||||||||
| Address2: | |||||||||
| City: | CLYDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3258934010 | ||||||||
| FaxNumber: | 3258934042 | ||||||||
| Practice Location | |||||||||
| Address1: | 1712 N ACCESS RD | ||||||||
| Address2: | |||||||||
| City: | CLYDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3258934010 | ||||||||
| FaxNumber: | 3258934042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 01/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | J1912 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8V4760 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |