Provider Demographics
NPI:1801869326
Name:CARTER, LARRY REX (ARNP, CNM)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:REX
Last Name:CARTER
Suffix:
Gender:M
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BOATNER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1302
Mailing Address - Country:US
Mailing Address - Phone:850-883-8600
Mailing Address - Fax:850-883-8057
Practice Address - Street 1:307 BOATNER RD SUITE 114
Practice Address - Street 2:96TH MEDICAL GROUP EGLIN
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-855-5983
Practice Address - Fax:850-883-8057
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2701812367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife