Healthcare Provider Details

I. General information

NPI: 1760845143
Provider Name (Legal Business Name): JAMES MILTON CARTER III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EMBARCADERO CTR LBBY
SAN FRANCISCO CA
94111-4174
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 415-529-4566
  • Fax:
Mailing address:
  • Phone: 410-658-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number266988
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA170291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: