Provider Demographics
NPI:1811398597
Name:CARTER-PLAKE, DAVID (LM, CPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARTER-PLAKE
Suffix:
Gender:M
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 E RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4815
Mailing Address - Country:US
Mailing Address - Phone:808-631-8612
Mailing Address - Fax:915-603-4411
Practice Address - Street 1:1312 E RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4815
Practice Address - Country:US
Practice Address - Phone:915-308-5000
Practice Address - Fax:915-603-4411
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
TX99327176B00000X
OHPN-100236-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes176B00000XOther Service ProvidersMidwife