Provider Demographics
NPI:1467594010
Name:CARTER, GRADY LEE III (DO)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:LEE
Last Name:CARTER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 HALEY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3876
Mailing Address - Country:US
Mailing Address - Phone:214-914-6773
Mailing Address - Fax:
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7029
Practice Address - Country:US
Practice Address - Phone:972-393-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1530207L00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P064Medicare ID - Type Unspecified