Healthcare Provider Details

I. General information

NPI: 1164000386
Provider Name (Legal Business Name): CARTER MAPLES PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

IV. Provider business mailing address

741 MARSHALL ROAD
FORT BLISS AA
79916
US

V. Phone/Fax

Practice location:
  • Phone: 567-288-0098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: