Healthcare Provider Details

I. General information

NPI: 1538165261
Provider Name (Legal Business Name): HARRY A CARTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 STACEY BURK DR
FLORA IL
62839-3241
US

IV. Provider business mailing address

2074 BOBWHITE RD
LOUISVILLE IL
62858-2032
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-2131
  • Fax:
Mailing address:
  • Phone: 618-599-6926
  • Fax: 618-665-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036096820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: