Provider Demographics
NPI:1821323833
Name:CARTER, SCOTT WILLIAM (IDC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:CARTER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8198 VALLEY VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8438
Mailing Address - Country:US
Mailing Address - Phone:850-207-4308
Mailing Address - Fax:
Practice Address - Street 1:8198 VALLEY VIEW CIR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8438
Practice Address - Country:US
Practice Address - Phone:850-207-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman