Provider Demographics
NPI:1710062732
Name:CARTER, LUTHER ICHIRO (MD)
Entity Type:Individual
Prefix:
First Name:LUTHER
Middle Name:ICHIRO
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 1:125 BAPTIST WAY STE 3A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2274
Mailing Address - Country:US
Mailing Address - Phone:448-227-6500
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:125 BAPTIST WAY STE 3A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2274
Practice Address - Country:US
Practice Address - Phone:448-227-6500
Practice Address - Fax:850-444-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107916207RI0011X
AL31078207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1710062732Medicaid
FL002617200Medicaid
AL102I067897Medicare PIN
FLDQ378ZMedicare UPIN
FLDQ387ZMedicare PIN