Individual
DR. RICHARD LEE CARPENTER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2734 CLEVELAND STREET, ELLOREE, SC 29047
(803) 897-2128
Mailing address
PO BOX 500, ELLOREE, SC 29047-0500
(803) 897-2128
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13542
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135428
—
SC
01
—
570889745
CHAMPUS #
SC
01
—
GP1311
MEDICAID GROUP #
SC
Enumeration date
01/02/2007
Last updated
07/09/2007
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