Healthcare Provider Details

I. General information

NPI: 1306532254
Provider Name (Legal Business Name): DANIEL IAN CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BOWLES AVE
FENTON MO
63026-2394
US

IV. Provider business mailing address

119 S GRAESER RD
SAINT LOUIS MO
63141-8313
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-2100
  • Fax:
Mailing address:
  • Phone: 314-440-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2026012388
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: