Provider Demographics
NPI:1609842012
Name:CARTER, RUSSELL H (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:H
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W JOHANNA ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4127
Mailing Address - Country:US
Mailing Address - Phone:512-732-7310
Mailing Address - Fax:512-732-7309
Practice Address - Street 1:1443 COUNTY ROAD 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-3854
Practice Address - Country:US
Practice Address - Phone:512-783-7889
Practice Address - Fax:512-732-7310
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4243392081P2900X
FLME934602081P2900X
TXMD5086208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014655970001Medicaid
I 44189Medicare UPIN