Provider Demographics
NPI:1326123043
Name:CARTER, KRISTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4046
Mailing Address - Country:US
Mailing Address - Phone:520-392-7600
Mailing Address - Fax:520-777-7703
Practice Address - Street 1:1615 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4046
Practice Address - Country:US
Practice Address - Phone:520-392-7600
Practice Address - Fax:520-777-7703
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25265207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ382268Medicaid
E41509Medicare UPIN
AZ382268Medicaid