Basic Information
| Provider Information | |||||||||
| NPI: | 1194145607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARMICAL | ||||||||
| FirstName: | JIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4TH FLOOR 1500 S. MAIN ST. | ||||||||
| Address2: | FAMILY HEALTH CENTER JPS | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177021215 | ||||||||
| FaxNumber: | 8177021697 | ||||||||
| Practice Location | |||||||||
| Address1: | 4TH FLOOR 1500 S. MAIN | ||||||||
| Address2: | FAMILY HEALTH CENTER JPS | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177021215 | ||||||||
| FaxNumber: | 8177021697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 05/03/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | E-10738 | AR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | Q8846 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.