Provider Demographics
NPI:1144451550
Name:CARTER, ANDY BRUCE (DO)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:BRUCE
Last Name:CARTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 RED FERN RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5472
Mailing Address - Country:US
Mailing Address - Phone:407-733-2037
Mailing Address - Fax:
Practice Address - Street 1:613 RED FERN RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5472
Practice Address - Country:US
Practice Address - Phone:407-733-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001537700Medicaid
FLCT570ZOtherMEDICARE PTAN