Provider Demographics
NPI:1861428898
Name:MCCARVER, BRIAN (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MCCARVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1914
Mailing Address - Country:US
Mailing Address - Phone:731-989-2174
Mailing Address - Fax:731-989-3891
Practice Address - Street 1:426 WHITE AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1914
Practice Address - Country:US
Practice Address - Phone:731-989-2174
Practice Address - Fax:731-989-3891
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN144224Medicaid
TN27403Medicaid
TN4063262OtherBLUE CROSS BLUE SHIELD H
TN4063255OtherBLUE CROSS BLUE SHIELD S
TN4063265OtherBLUE CROSS BLUE SHIELD A
TN3717101Medicaid
TN27403Medicaid
TN3880370Medicare ID - Type Unspecified
TN4063262OtherBLUE CROSS BLUE SHIELD H