Provider Demographics
NPI:1871724385
Name:E CARWILE LEROY JR MD INC A MEDICAL CORPORATION
Entity type:Organization
Organization Name:E CARWILE LEROY JR MD INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-325-3070
Mailing Address - Street 1:1805 E FIR AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3859
Mailing Address - Country:US
Mailing Address - Phone:559-325-3070
Mailing Address - Fax:
Practice Address - Street 1:1805 E FIR AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3859
Practice Address - Country:US
Practice Address - Phone:559-325-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53624208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABY008ZMedicare PIN