Provider Demographics
NPI:1134111792
Name:CARTER, KEITH BAXTER (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BAXTER
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-585-1200
Mailing Address - Fax:502-585-1207
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-585-1200
Practice Address - Fax:502-585-1207
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049358OtherPASSPORT
KY000000051842OtherANTHEM
KYK022721OtherKY MEDICARE
KYK022721-KOHMGOtherKY MEDICARE
KY64245590Medicaid
KY100349310AOtherINDIANA MEDICAID
KY110170684OtherRAILROAD MEDICARE
KYK022721Medicare Oscar/Certification
KY1049358OtherPASSPORT
KYC71391Medicare UPIN