Provider Demographics
NPI:1245213479
Name:CARTER, CHAD C (DO)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:C
Last Name:CARTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2406 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-4882
Mailing Address - Country:US
Mailing Address - Phone:405-921-7457
Mailing Address - Fax:618-256-6133
Practice Address - Street 1:2400 EAST DR RM 135
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5408
Practice Address - Country:US
Practice Address - Phone:618-256-5267
Practice Address - Fax:618-256-6133
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4286208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice