Provider Demographics
NPI:1124185772
Name:ROBERT L CARTER MD PC
Entity Type:Organization
Organization Name:ROBERT L CARTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-623-7700
Mailing Address - Street 1:1617 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0322
Mailing Address - Country:US
Mailing Address - Phone:417-623-7700
Mailing Address - Fax:417-623-0565
Practice Address - Street 1:1617 W 26TH STREET
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-623-7700
Practice Address - Fax:417-623-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505214601Medicaid
MO000000010654OtherANTHEM BCBS
MO000013277Medicare PIN
MOK48000Medicare PIN
MO000013278Medicare PIN
MO505214601Medicaid