Basic Information
| Provider Information | |||||||||
| NPI: | 1194763912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | DOYLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5757 W THUNDERBIRD RD | ||||||||
| Address2: | SUITE W-400 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025471400 | ||||||||
| FaxNumber: | 6025471401 | ||||||||
| Practice Location | |||||||||
| Address1: | 5757 W THUNDERBIRD RD | ||||||||
| Address2: | SUITE W-400 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025471400 | ||||||||
| FaxNumber: | 6025471401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4322 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 067678 | 01 | AZ | AHCCCS | OTHER |