Provider Demographics
NPI:1851338438
Name:CARTER, GUY A (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:A
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:500 N KEENE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-219-3960
Practice Address - Fax:573-219-3964
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103638208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206670804Medicaid
MO222895OtherHEALTHLIN
MO817010635Medicare PIN
MO922435236Medicare PIN
MO152360236Medicare PIN
MO222895OtherHEALTHLIN