Healthcare Provider Details

I. General information

NPI: 1407850308
Provider Name (Legal Business Name): BART J CARTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date: 03/21/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

2240 W 16TH ST
SAFFORD AZ
85546-4081
US

IV. Provider business mailing address

2240 W 16TH ST
SAFFORD AZ
85546-4081
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-4030
  • Fax: 923-834-0403
Mailing address:
  • Phone: 928-348-4030
  • Fax: 923-834-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: