# BRENT W CARMACK MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427238211
- **Authorized official:** MS. LEILA CARLEEN LAWRENCE CPOT (ADMINISTRATOR)
- **Authorized official phone:** (727) 789-2020

## Contact information

- **Practice address:** 900 CARILLON PKWY, STE 111, ST PETERSBURG, FL 33716-1121
- **Practice address phone:** (727) 573-3937
- **Practice address fax:** (727) 573-4344
- **Mailing address:** 900 CARILLON PKWY, STE 111, ST PETERSBURG, FL 33716-1121
- **Mailing address phone:** (727) 573-3937
- **Mailing address fax:** (727) 573-4344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME89731 | FL | Yes |

## Other

- **Enumeration date:** 11/08/2007
- **Last updated:** 12/12/2012