Provider Demographics
NPI:1700813722
Name:CARTER, RICHARD GIPSON (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GIPSON
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 1:6323 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8020
Mailing Address - Country:US
Mailing Address - Phone:225-921-2422
Mailing Address - Fax:
Practice Address - Street 1:6323 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8020
Practice Address - Country:US
Practice Address - Phone:225-921-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11697208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158283Medicaid
50360Medicare ID - Type Unspecified
LA1158283Medicaid