Provider Demographics
NPI:1053369413
Name:CARTER, TIMOTHY CRAIG (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5555 ANGLERS AVENUE
Mailing Address - Street 2:SUITE 24 FLORIDA UNITED RADIOLOGY
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312
Mailing Address - Country:US
Mailing Address - Phone:954-962-6265
Mailing Address - Fax:954-893-9595
Practice Address - Street 1:13001 SOUTHERN BOULEVARD
Practice Address - Street 2:PALMS WEST HOSPITAL
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-784-3238
Practice Address - Fax:561-784-3109
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME820852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81149Medicare UPIN
FL589092Medicare ID - Type Unspecified