Basic Information
| Provider Information | |||||||||
| NPI: | 1285693424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BERNARD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 2877 | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919432877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197404941 | ||||||||
| FaxNumber: | 6197404418 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 GROSSMONT CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919440158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197404492 | ||||||||
| FaxNumber: | 6197404418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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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 | 207ZC0500X | G39979 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | G39979 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | G-39979 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | WG399790 | 01 | CA | DHS PPIN | OTHER |