Basic Information
| Provider Information | |||||||||
| NPI: | 1932115730 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEROME O. CARTER, MD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 GARTH ROAD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814209355 | ||||||||
| FaxNumber: | 2814209332 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 GARTH ROAD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814209355 | ||||||||
| FaxNumber: | 2814209332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | OSSORIO | ||||||||
| AuthorizedOfficialFirstName: | EUDE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7139950042 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | ADMINISTRATOR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | L8298 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0032NV | 01 | TX | BLUE CROSS BLUE SHEILD | OTHER |