Provider Demographics
NPI:1407850308
Name:CARTER, BART J (MD)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:J
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 1:2240 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-4081
Mailing Address - Country:US
Mailing Address - Phone:928-348-4030
Mailing Address - Fax:923-834-0403
Practice Address - Street 1:2240 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4081
Practice Address - Country:US
Practice Address - Phone:928-348-4030
Practice Address - Fax:923-834-0403
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2020-01-29
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AZ19854174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008351Medicaid
AZ008351Medicaid
AZZMD19854Medicare ID - Type Unspecified