Provider Demographics
NPI:1497721344
Name:CARTER, CRAIG B (MD FACS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 3RD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1905
Mailing Address - Country:US
Mailing Address - Phone:626-915-8585
Mailing Address - Fax:626-915-0685
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1915
Practice Address - Country:US
Practice Address - Phone:626-915-8585
Practice Address - Fax:626-915-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G518131Medicaid
CA00G518131Medicaid
CAG51813Medicare PIN