Provider Demographics
NPI:1326170911
Name:CARTER, JAMES BRYAN (CERTIFIED SURGICAL A)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRYAN
Last Name:CARTER
Suffix:
Gender:M
Credentials:CERTIFIED SURGICAL A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30171 PEGGY LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7227
Mailing Address - Country:US
Mailing Address - Phone:720-319-3236
Mailing Address - Fax:303-744-1557
Practice Address - Street 1:30171 PEGGY LN
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7227
Practice Address - Country:US
Practice Address - Phone:720-319-3236
Practice Address - Fax:303-744-1557
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0001011246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1326170911Medicare UPIN