Provider Demographics
NPI:1124028956
Name:CARTER, GAYLE M
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:M
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S 300 E
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3900
Mailing Address - Country:US
Mailing Address - Phone:435-628-0498
Mailing Address - Fax:435-628-1897
Practice Address - Street 1:515 S 300 E
Practice Address - Street 2:SUITE 206
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3900
Practice Address - Country:US
Practice Address - Phone:435-628-0498
Practice Address - Fax:435-628-1897
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT166602-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT06757Medicaid
UTD07573Medicare UPIN