Healthcare Provider Details

I. General information

NPI: 1669468807
Provider Name (Legal Business Name): JACQUELINE MAY CARTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6828 E BROWN RD STE 102
MESA AZ
85207-3761
US

IV. Provider business mailing address

6828 E BROWN RD STE 102
MESA AZ
85207-3761
US

V. Phone/Fax

Practice location:
  • Phone: 480-981-8650
  • Fax: 480-981-1563
Mailing address:
  • Phone: 480-981-8650
  • Fax: 480-981-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32951
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32951
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: