Individual
EDWIN BLOUNT CARMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
(509) 665-6065
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00048684
WA
208M00000X
Hospitalist Physician
Primary
MD00048684
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0225361
L&I
WA
05
—
1174504302
—
WA
01
—
315405
L&I POST 7/21/13
WA
01
—
8945510
CRIME VICTIMS
WA
01
—
P01292756
RR MEDICARE
WA
Enumeration date
11/05/2005
Last updated
11/12/2020
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