Provider Demographics
NPI:1023001161
Name:CARTER, SANDRA (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:BLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1720
Mailing Address - Country:US
Mailing Address - Phone:541-271-2119
Mailing Address - Fax:541-271-9338
Practice Address - Street 1:600 RANCH RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1720
Practice Address - Country:US
Practice Address - Phone:541-271-2119
Practice Address - Fax:541-271-9338
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004004157207R00000X
KS05-31742207R00000X
ORDO153439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2197141OtherFIRST HEALTH
MOP00162661OtherRR MCR
MO208976001Medicaid
33737014OtherBCBS
7620522OtherAETNA
MO208976001Medicaid
MOP00162661OtherRR MCR
I03721Medicare UPIN