Individual
CHARLES MARK CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E 2ND ST, SUITE 206, RENO, NV 89502-1181
(775) 789-7000
(775) 789-7040
Mailing address
1500 E 2ND ST, SUITE 206, RENO, NV 89502-1181
(775) 789-7000
(775) 789-7040
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4665
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002016467
—
NV
01
—
CC4367
ANTHEM BCBS
NV
01
—
CC4367
BCBS
—
05
—
XPY187231
—
CA
Enumeration date
10/11/2005
Last updated
11/04/2011
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