Provider Demographics
NPI:1366627655
Name:CARTER, COURTNEY M (DO)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OAKLAND PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1550
Mailing Address - Country:US
Mailing Address - Phone:817-546-1106
Mailing Address - Fax:817-534-6141
Practice Address - Street 1:3201 WESTERN CENTER BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-7134
Practice Address - Country:US
Practice Address - Phone:817-546-1106
Practice Address - Fax:817-534-6141
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0229208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics