Provider Demographics
NPI:1346331444
Name:CARTER, RICHARD ALAN (D O)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:CARTER
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W I 20 UNIT G10
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5871
Mailing Address - Country:US
Mailing Address - Phone:817-557-5036
Mailing Address - Fax:817-557-6850
Practice Address - Street 1:811 W INTERSTATE 20 UNIT G10
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5871
Practice Address - Country:US
Practice Address - Phone:817-557-5036
Practice Address - Fax:817-557-6850
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6913208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098589702Medicaid
TX098589704Medicaid
TX098589705Medicaid
TX098589703Medicaid
00GE79Medicare ID - Type Unspecified
TX098589702Medicaid
TX8L17250Medicare PIN
TX098589704Medicaid
TX098589703Medicaid