Active NPI
Bruce Wayne Carlin, MD
- Urology Physician
- Coalville, UT
National Provider Identifier
1164845517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 160374-1205
- Practice address
- 375 Old Farm LN
Coalville, UT 84017-6706 - Phone
- (360) 355-9354
- NPI assigned
- Jan 21, 2014
- Last updated
- Apr 15, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 160374-1205 | UT | Primary |
Addresses
Primary practice location
375 Old Farm LN
Coalville, UT 84017-6706
Mailing address
PO Box 412
Camas, WA 98607-0049
Phone (360) 590-3095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160374-1205 | UT | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586908800000",
"number": "1164845517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 412",
"city": "CAMAS",
"state": "WA",
"postal_code": "986070049",
"telephone_number": "360-590-3095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 OLD FARM LN",
"city": "COALVILLE",
"state": "UT",
"postal_code": "840176706",
"telephone_number": "360-355-9354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLIN",
"first_name": "BRUCE",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-21",
"last_updated": "2020-04-15",
"certification_date": "2020-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "UT",
"license": "160374-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coalville, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.