Provider Demographics
NPI:1528002797
Name:CARTER, KYLE K (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:K
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4125 FAIRWAY DRIVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-939-4555
Mailing Address - Fax:912-939-7020
Practice Address - Street 1:4125 FAIRWAY DRIVE
Practice Address - Street 2:SUITE 190
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-939-4555
Practice Address - Fax:912-939-7020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23363Medicare UPIN