Provider Demographics
NPI:1841420437
Name:HENRY S CARTER, MD LLC
Entity Type:Organization
Organization Name:HENRY S CARTER, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-463-4800
Mailing Address - Street 1:305 W 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4982
Mailing Address - Country:US
Mailing Address - Phone:337-463-4800
Mailing Address - Fax:337-462-0067
Practice Address - Street 1:305 W 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4982
Practice Address - Country:US
Practice Address - Phone:337-463-4800
Practice Address - Fax:337-462-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01153R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1020095Medicaid
LAB61709Medicare UPIN
LA1020095Medicaid