Individual
MARY S CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
809 JACKSON ST, BURKE, SD 57523-2065
(605) 775-2631
(605) 775-2564
Mailing address
809 JACKSON STREET, PO BOX 358, BURKE, SD 57523
(605) 775-2631
(605) 775-2564
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1484
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0851370001
DME
—
05
—
5604130
—
SD
05
—
5604132
—
SD
05
—
5604133
—
SD
Enumeration date
10/18/2006
Last updated
12/06/2013
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