Provider Demographics
NPI:1013976794
Name:CARTER, DARRELL L (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:L
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:295 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-1456
Mailing Address - Country:US
Mailing Address - Phone:320-564-2511
Mailing Address - Fax:320-564-4180
Practice Address - Street 1:295 10TH AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1456
Practice Address - Country:US
Practice Address - Phone:320-564-2511
Practice Address - Fax:320-564-2511
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN20225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D75582Medicare UPIN