Provider Demographics
NPI:1336247964
Name:CARTER, ETHELRED ERASMUS (MD)
Entity Type:Individual
Prefix:
First Name:ETHELRED
Middle Name:ERASMUS
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:SUITE #3700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2424
Mailing Address - Country:US
Mailing Address - Phone:323-260-7252
Mailing Address - Fax:323-260-7864
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE #3700
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-260-7252
Practice Address - Fax:323-260-7864
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29534207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A295340Medicaid