Individual
DR. BRUCE D CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 VILLAGE RD, 108, GRANBURY, TX 76049-4193
(817) 573-0444
(817) 573-2733
Mailing address
409 GLENWOOD ST, 500, GLEN ROSE, TX 76043-4933
(254) 897-2202
(254) 897-1638
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F6508
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130769611
—
TX
05
—
191011901
—
TX
Enumeration date
05/04/2006
Last updated
01/12/2017
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