Provider Demographics
NPI:1467706796
Name:CARTER, VINCENT MATTHEW
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:MATTHEW
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NW HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4156
Mailing Address - Country:US
Mailing Address - Phone:580-510-0272
Mailing Address - Fax:
Practice Address - Street 1:820 NW HAMPTON CT
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4156
Practice Address - Country:US
Practice Address - Phone:580-510-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor