Healthcare Provider Details

I. General information

NPI: 1558868356
Provider Name (Legal Business Name): STEPHEN CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

1 HOSPITAL DRIVE, DEPT OF RADIOLOGY
COLUMBIA MO
65212
US

V. Phone/Fax

Practice location:
  • Phone: 314-770-9393
  • Fax: 814-770-9997
Mailing address:
  • Phone: 573-882-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036168993
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2024011987
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: