Individual
MATHEIS W CARRICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3346 PROFESSIONAL PARK DR, OWENSBORO, KY 42303-4551
(270) 685-1066
(270) 685-0881
Mailing address
3346 PROFESSIONAL PARK DR, OWENSBORO, KY 42303-4551
(270) 685-1066
(270) 685-0881
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39371
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20524260
—
IN
01
—
369694
BLUE CROSS
KY
01
—
50007250
PASS PORT
KY
05
—
64098486
—
KY
Enumeration date
09/28/2005
Last updated
03/23/2012
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