MEDICARE: BRYAN PATRICK CARTER PA-C

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	363AM0700X	Medical Physician Assistant	PA9102219	FL

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	:	1578563599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN PATRICK CARTER PA-C

Provider Business Mailing Address
First Line	:	8575 NE 138TH LN
Second Line	:	SUITE 203
City	:	LADY LAKE
State	:	FL
Zip	:	32159-8996
Country	:	US
Telephone Number	:	352-674-2080
Fax Number	:	352-674-2177

Provider Business Practice Location Address
First Line	:	1149 MAIN ST
Second Line	:
City	:	THE VILLAGES
State	:	FL
Zip	:	32159-7721
Country	:	US
Telephone Number	:	352-674-2080
Fax Number	:	352-674-2177

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	05/05/2017

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Directions to “ BRYAN PATRICK CARTER PA-C” Practice Location

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