Provider Demographics
NPI:1134101132
Name:CARTER, RANDALL MATTHEW
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:MATTHEW
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 1:12707 MURPHY RD
Mailing Address - Street 2:SUITE #71
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3029
Mailing Address - Country:US
Mailing Address - Phone:281-568-9668
Mailing Address - Fax:
Practice Address - Street 1:12707 MURPHY RD
Practice Address - Street 2:SUITE #71
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3029
Practice Address - Country:US
Practice Address - Phone:281-568-9668
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175L00000X175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath