Healthcare Provider Details

I. General information

NPI: 1326170911
Provider Name (Legal Business Name): JAMES BRYAN CARTER CERTIFIED SURGICAL A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30171 PEGGY LN
EVERGREEN CO
80439-7227
US

IV. Provider business mailing address

30171 PEGGY LN
EVERGREEN CO
80439-7227
US

V. Phone/Fax

Practice location:
  • Phone: 720-319-3236
  • Fax: 303-744-1557
Mailing address:
  • Phone: 720-319-3236
  • Fax: 303-744-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA.0001011
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: