Basic Information
| Provider Information | |||||||||
| NPI: | 1710062732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARTER | ||||||||
| FirstName: | LUTHER | ||||||||
| MiddleName: | ICHIRO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 N E ST | ||||||||
| Address2: | SUITE 331 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325016339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504846500 | ||||||||
| FaxNumber: | 8508571747 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 N E ST | ||||||||
| Address2: | SUITE 331 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325016339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504846500 | ||||||||
| FaxNumber: | 8504441755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 12/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 31078 | AL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | ME107916 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1710062732 | 05 | AL | MEDICAID | 002617200 | 05 | FL | MEDICAID |