MEDICARE: DR. CARTER D. POAGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	Q6265	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134483746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARTER D. POAGE M.D.

Provider Business Mailing Address
First Line	:	3001 WESLAYAN ST. SUITE 360
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2326
Country	:	US
Telephone Number	:	713-528-0156
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 WESLAYAN ST.
Second Line	:	SUITE NUMBER 360
City	:	HOUSTON
State	:	TX
Zip	:	77027-5756
Country	:	US
Telephone Number	:	713-528-0156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	09/02/2016

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