MEDICARE: KENNETH O. CARTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME127103	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073547543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH O. CARTER M.D.

Provider Business Mailing Address
First Line	:	235 3RD AVE N UNIT 551
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3383
Country	:	US
Telephone Number	:	704-953-8039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BAY PINES BLVD.
Second Line	:
City	:	BAY PINES
State	:	FL
Zip	:	33744
Country	:	US
Telephone Number	:	727-273-6828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/01/2019

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