Provider Demographics
NPI:1497827695
Name:CARTER, DENVER L III (DPM DOCTOR OF PEDIAT)
Entity Type:Individual
Prefix:DR
First Name:DENVER
Middle Name:L
Last Name:CARTER
Suffix:III
Gender:M
Credentials:DPM DOCTOR OF PEDIAT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1663 SIMPSON HWY 49
Mailing Address - Street 2:STE 1
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111
Mailing Address - Country:US
Mailing Address - Phone:601-849-0444
Mailing Address - Fax:601-849-0404
Practice Address - Street 1:1663 SIMPSON HWY 49
Practice Address - Street 2:STE 1
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111
Practice Address - Country:US
Practice Address - Phone:601-849-0444
Practice Address - Fax:601-849-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80174213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00079556OtherRR MCR
MS05476851Medicaid
480000138Medicare PIN
4883550001Medicare NSC
P00079556OtherRR MCR