Basic Information
| Provider Information | |||||||||
| NPI: | 1922197698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATER | ||||||||
| FirstName: | WILLIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE HOSPITAL ROAD | ||||||||
| Address2: | P.O. BOX 1477 | ||||||||
| City: | OAK BLUFFS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025571477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086930410 | ||||||||
| FaxNumber: | 5086935971 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE HOSPITAL ROAD | ||||||||
| Address2: | |||||||||
| City: | OAK BLUFFS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025571477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086930410 | ||||||||
| FaxNumber: | 5086935971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 10/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 34911 | MA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | A66107 | 05 | MA | MEDICAID |