Russell P Carter Jr MD Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G35573 Issued in CA

Legal business name

RUSSELL P CARTER JR MD INC

Practice address

200 Cottage Ave
Suite 201
Manteca, CA 95336-4935

Phone

(209) 239-4554

Fax

(209) 239-4011

NPI assigned

Nov 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Russell Philip Carter Jr., MD

Title

President/Physician

Phone

(209) 239-4554

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1841471166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 COTTAGE AVE",
            "address_2": "SUITE 201",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364935",
            "telephone_number": "209-239-4554",
            "fax_number": "209-239-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COTTAGE AVE",
            "address_2": "SUITE 201",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364935",
            "telephone_number": "209-239-4554",
            "fax_number": "209-239-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL P CARTER JR MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "209-239-4554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G35573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G355730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Manteca, CA
• Providers in Manteca, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.