Individual
DR. ROBERT GIBSON CARNEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1770 E LAKE SHORE DR, SUITE #301, DECATUR, IL 62521-3832
(217) 429-2636
(217) 429-2687
Mailing address
1770 E LAKE SHORE DR, SUITE #301, DECATUR, IL 62521-3832
(217) 429-2636
(217) 429-2687
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036-049753
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00882
PAYER ID
IL
05
—
036049753
—
IL
01
—
071128778
RR MEDICARE PROVIDER
IL
Enumeration date
04/19/2006
Last updated
01/08/2011
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