Provider Demographics
NPI:1043320583
Name:CARTER, RAPHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:A
Last Name:CARTER
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 1:7830 PERSIMMON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-7926
Mailing Address - Country:US
Mailing Address - Phone:812-497-0660
Mailing Address - Fax:812-358-2446
Practice Address - Street 1:7830 PERSIMMON LAKE DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-7926
Practice Address - Country:US
Practice Address - Phone:812-497-0660
Practice Address - Fax:812-358-2446
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044045A207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200061980AMedicaid
INF84006Medicare UPIN
IN200061980AMedicaid