Provider Demographics
NPI:1053390674
Name:CARTER, DOUGLAS B II (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:CARTER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1931 65TH AVE
Mailing Address - Street 2:#C
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7946
Mailing Address - Country:US
Mailing Address - Phone:970-352-1877
Mailing Address - Fax:970-356-9274
Practice Address - Street 1:1931 65TH AVE
Practice Address - Street 2:#C
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7946
Practice Address - Country:US
Practice Address - Phone:970-352-1877
Practice Address - Fax:970-356-9274
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO28078207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280783Medicaid
CO01280783Medicaid
COD25038Medicare UPIN