Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 2009-0003 | NC |
Y | 207U00000X | Nuclear Medicine Specialist | ME119355 | FL |
NPI | 1659582286 |
---|---|
Provider Name | Shawn Stafford Carter |
First Address | Fort Myers, FL 33901-8005 |
Second Address | Fort Myers, FL 33901-8005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017414000 | (05) | FL |
ITM0X | FLORIDA BCBS (01) | FL |
OU964 | HF MEDICARE (01) | FL |