Healthcare Provider Details

I. General information

NPI: 1487865937
Provider Name (Legal Business Name): MARTIN JOHN CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MARVEL ST
COUSHATTA LA
71019-9022
US

IV. Provider business mailing address

1633 MARVEL ST
COUSHATTA LA
71019-9022
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-9980
  • Fax:
Mailing address:
  • Phone: 318-932-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number202452
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.202452
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: