Provider Demographics
NPI:1952645194
Name:CARTER, MARCUS ANTONIO (CST/CSFA)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANTONIO
Last Name:CARTER
Suffix:
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 LADD LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1519
Mailing Address - Country:US
Mailing Address - Phone:903-220-1848
Mailing Address - Fax:903-807-0023
Practice Address - Street 1:2902 LADD LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1519
Practice Address - Country:US
Practice Address - Phone:903-220-1848
Practice Address - Fax:903-807-0023
Is Sole Proprietor?:No
Enumeration Date:2012-11-11
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO127211246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist