Individual
MARK MERRITT CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 BOB WALLACE AVE SW, HUNTSVILLE, AL 35801-3843
(256) 533-0335
(256) 539-9880
Mailing address
420 LOWELL DR SE, STE 103, HUNTSVILLE, AL 35801-3754
(256) 535-5940
(256) 535-5954
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9843
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000051905
—
AL
01
—
0004003511
AETNA IDENTIFICATION NO
—
01
—
51051905
BLUE CROSS BLUE SHIELD
AL
Enumeration date
11/11/2005
Last updated
07/08/2007
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