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NPI Code Detail

MEDICARE: JACQUELYN LEIGH CARTER M.D.

MEDICARE: JACQUELYN LEIGH 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
12080P0207XPediatric Hematology & Oncology Physician01073830IN
22080P0207XPediatric Hematology & Oncology Physician2020012907MO

General Provider Information

NPI Number : 1881983625
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN LEIGH CARTER M.D.
Provider Business Mailing Address
First Line : 607 S NEW BALLAS RD STE 2415
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8234
Country : US
Telephone Number : 314-251-6986
Fax Number : 314-251-5712
Provider Business Practice Location Address
First Line : 607 S NEW BALLAS RD STE 2415
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8234
Country : US
Telephone Number : 314-251-6986
Fax Number : 314-251-5712
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2011
Last Update Date : 12/01/2022

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Directions to “ JACQUELYN LEIGH CARTER M.D.” Practice Location

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