Provider Demographics
NPI:1316476070
Name:CARTER, ISAAC WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:WILLIAM
Last Name:CARTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 MERCERS FERNERY RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2135
Mailing Address - Country:US
Mailing Address - Phone:225-456-1225
Mailing Address - Fax:
Practice Address - Street 1:222 S PENINSULA DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4422
Practice Address - Country:US
Practice Address - Phone:386-310-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS19805207P00000X
390200000X
LA326532207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program