Provider Demographics
NPI:1093109704
Name:CARTER, CRYSTAL (DO)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7979 W VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3798
Mailing Address - Country:US
Mailing Address - Phone:972-780-8400
Mailing Address - Fax:972-656-0380
Practice Address - Street 1:7979 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3798
Practice Address - Country:US
Practice Address - Phone:972-780-8400
Practice Address - Fax:972-656-0380
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013488207R00000X
TXT7882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine