Provider Demographics
NPI:1245487156
Name:JENNIFER W. CARL, M.D.,PC
Entity type:Organization
Organization Name:JENNIFER W. CARL, M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-379-5743
Mailing Address - Street 1:2528 WHEATON WAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3305
Mailing Address - Country:US
Mailing Address - Phone:360-379-5743
Mailing Address - Fax:360-373-7054
Practice Address - Street 1:2528 WHEATON WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3305
Practice Address - Country:US
Practice Address - Phone:360-379-5743
Practice Address - Fax:360-373-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021898208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty