Provider Demographics
NPI:1730117060
Name:CARTER, TYLER J (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
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 1:4523 E LAMIRADA WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044
Mailing Address - Country:US
Mailing Address - Phone:602-438-0848
Mailing Address - Fax:
Practice Address - Street 1:600 S DOBSON
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-814-1560
Practice Address - Fax:480-814-1799
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ722571Medicaid
AZZ102276Medicare PIN
AZZ73045Medicare PIN
H76819Medicare UPIN