MEDICARE: GRANT L CARTER 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	207V00000X	Obstetrics & Gynecology Physician	163965-1205	UT
2	207VG0400X	Gynecology Physician	163965-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215937032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT L CARTER M.D.

Provider Business Mailing Address
First Line	:	1068 E RIVERSIDE DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4477
Country	:	US
Telephone Number	:	435-628-6466
Fax Number	:	435-628-3845

Provider Business Practice Location Address
First Line	:	1068 E RIVERSIDE DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4477
Country	:	US
Telephone Number	:	435-628-6466
Fax Number	:	435-628-3845

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	06/27/2011

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