Provider Demographics
NPI:1194854067
Name:CARTER, JONATHAN TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TODD
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 1:1716 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-4025
Mailing Address - Country:US
Mailing Address - Phone:415-577-4564
Mailing Address - Fax:
Practice Address - Street 1:513 PARNASSUS AVE RM S-321
Practice Address - Street 2:UCSF DEPARTMENT OF SURGERY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0470
Practice Address - Country:US
Practice Address - Phone:415-514-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77227208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery