Provider Demographics
NPI:1932115730
Name:JEROME O. CARTER, MD, PLLC
Entity Type:Organization
Organization Name:JEROME O. CARTER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:713-995-0042
Mailing Address - Street 1:4200 GARTH ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-420-9355
Mailing Address - Fax:281-420-9332
Practice Address - Street 1:4200 GARTH ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-420-9355
Practice Address - Fax:281-420-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL82982081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032NVOtherBLUE CROSS BLUE SHEILD
TX=========OtherEMPLOYER IDENTIFICATION N
TX0032NVOtherBLUE CROSS BLUE SHEILD