1245496157 NPI number — DR. FREDERICK THACHER CARTER PSYD

Table of content: DR. FREDERICK THACHER CARTER PSYD (NPI 1245496157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245496157 NPI number — DR. FREDERICK THACHER CARTER PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
FREDERICK
Provider Middle Name:
THACHER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245496157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63670 OWSLEY CANYON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANDE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97850-5177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-962-7491
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 FIR ST
Provider Second Line Business Practice Location Address:
SUITE 332
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-910-0212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1172 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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