Provider Demographics
NPI:1689698961
Name:CARTER, JEROME O (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:O
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEROME
Other - Middle Name:O
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:720 ROLLINGBROOK
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-420-9355
Mailing Address - Fax:281-420-9332
Practice Address - Street 1:720 ROLLINGBROOK
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-420-9355
Practice Address - Fax:281-420-9332
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL82982081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL8298OtherMEDICAL LICENSE
TX8W2350OtherBLUE CROSS BLUE SHIELD
TXL8298OtherMEDICAL LICENSE
TX8F3922Medicare PIN