Provider Demographics
NPI:1326098310
Name:CARTER, ENRIQUE DELANO (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:DELANO
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 1:1200 N 14TH AVE
Mailing Address - Street 2:SUITE 300 C
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4182
Mailing Address - Country:US
Mailing Address - Phone:509-545-0210
Mailing Address - Fax:509-545-8708
Practice Address - Street 1:1200 N 14TH AVE
Practice Address - Street 2:SUITE 300 C
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4182
Practice Address - Country:US
Practice Address - Phone:509-545-0210
Practice Address - Fax:509-545-8708
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014484174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1087253Medicaid
WA1087253Medicaid
WAF73691Medicare UPIN