Provider Demographics
NPI:1871652719
Name:HENRI R CARTER MD
Entity Type:Organization
Organization Name:HENRI R CARTER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HENRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-3250
Mailing Address - Street 1:2503 S AVENUE A #3
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7174
Mailing Address - Country:US
Mailing Address - Phone:928-344-3250
Mailing Address - Fax:928-344-3253
Practice Address - Street 1:2503 S AVENUE A #3
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7174
Practice Address - Country:US
Practice Address - Phone:928-344-3250
Practice Address - Fax:928-344-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16179208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0256980OtherBCBS
AZ277576Medicaid
C72155Medicare UPIN
AZ277576Medicaid