Provider Demographics
NPI:1689657967
Name:CARRAHER, JOHN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:CARRAHER
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:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-1446
Mailing Address - Country:US
Mailing Address - Phone:731-427-9971
Mailing Address - Fax:731-424-2052
Practice Address - Street 1:28 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3947
Practice Address - Country:US
Practice Address - Phone:731-427-9971
Practice Address - Fax:731-424-2052
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000026150208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3837314Medicaid
TN4061705OtherBLUE CROSS BLUE SHIELD
TN8706792OtherCIGNA
TN07080032OtherAETNA
TN3837314Medicaid
TNG86998Medicare UPIN
TNP00021963Medicare ID - Type UnspecifiedRAILROAD MEDICARE