Provider Demographics
NPI:1639880339
Name:MAYOTTE, CARTER (RA)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:
Last Name:MAYOTTE
Suffix:
Gender:M
Credentials:RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 FNB PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-7200
Mailing Address - Country:US
Mailing Address - Phone:402-493-1212
Mailing Address - Fax:866-363-5291
Practice Address - Street 1:933 E PIERCE ST
Practice Address - Street 2:ATTN: RADIOLOGY DEPT
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4652
Practice Address - Country:US
Practice Address - Phone:712-396-6140
Practice Address - Fax:712-396-6227
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARAD103746243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant