Provider Demographics
NPI:1760456032
Name:CARTER, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
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 1:2302 N STOCKTON HILL RD STE G
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4100
Mailing Address - Country:US
Mailing Address - Phone:928-718-2225
Mailing Address - Fax:928-718-2226
Practice Address - Street 1:2302 N STOCKTON HILL RD STE G
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4100
Practice Address - Country:US
Practice Address - Phone:928-718-2225
Practice Address - Fax:928-718-2226
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ899578Medicaid
AZ31559OtherMEDICAL LICENSE
AZ101528Medicare ID - Type Unspecified
AZI26653Medicare UPIN