Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 06901 | MS |
NPI | 1053371807 |
---|---|
Provider Name | Dr. Michael Carter |
First Address | Greenwood, MS 38935-1410 |
Second Address | Greenwood, MS 38930-4035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 15/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00125742 | (05) | MS |
P00382110 | MEDICARE RAILROAD (01) |