Provider Demographics
NPI:1760428973
Name:CARTER, SAMUEL R III (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:R
Last Name:CARTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2024 S MAIDEN LN STE 203
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0319
Mailing Address - Country:US
Mailing Address - Phone:417-659-4661
Mailing Address - Fax:417-659-8509
Practice Address - Street 1:2024 S MAIDEN LN STE 203
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0319
Practice Address - Country:US
Practice Address - Phone:417-659-4661
Practice Address - Fax:417-659-8509
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO109788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110136988OtherRR MEDICARE
KS100188880AMedicaid
MO31655OtherANTHEM
OK100069440AMedicaid
MO208238105Medicaid
MO31655OtherANTHEM
G26154Medicare UPIN