Healthcare Provider Details

I. General information

NPI: 1912746058
Provider Name (Legal Business Name): JEREMY CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH HEALTH CLINIC YUMA 2917 EAST HART ST
YUMA AZ
85369
US

IV. Provider business mailing address

2010 W GREGORY ST
PENSACOLA FL
32502-3609
US

V. Phone/Fax

Practice location:
  • Phone: 928-269-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101286684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: