Basic Information
| Provider Information | |||||||||
| NPI: | 1356326979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN DE CARR | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3904 DELL RD | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956082610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169441079 | ||||||||
| FaxNumber: | 9199440115 | ||||||||
| Practice Location | |||||||||
| Address1: | 11000 OLSON DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956705653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166354120 | ||||||||
| FaxNumber: | 9166357134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G031151 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.