Individual
DR. CHARLES R CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5444 GREEN ST, MURRAY, UT 84123-5632
(801) 286-2812
(801) 262-5721
Mailing address
5444 GREEN ST, MURRAY, UT 84123-5632
(801) 262-2647
(801) 262-3897
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
162938-1205
UT
2085R0202X
Diagnostic Radiology Physician
M-4291
ID
2085R0204X
Vascular & Interventional Radiology Physician
Primary
162938-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D5611
—
UT
Enumeration date
06/01/2006
Last updated
09/04/2012
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