Provider Demographics
NPI:1740490903
Name:CARTER, BRETT WILSON (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:WILSON
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 N GLEN DR
Mailing Address - Street 2:APT. #3037
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7224
Mailing Address - Country:US
Mailing Address - Phone:972-556-2968
Mailing Address - Fax:
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-841-3017
Practice Address - Fax:214-826-9792
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2430082085R0202X
TXN15742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology