=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326521972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALICIA R. CARTER, M.D., L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2018
-----------------------------------------------------
Last Update Date | 09/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4770 BISCAYNE BLVD STE 1100
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-680-3527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4770 BISCAYNE BLVD STE 1100
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-680-3527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALICIA R CARTER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-680-3527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------