Provider Demographics
NPI:1972618312
Name:CARTER, GREGORY EDWARD (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:EDWARD
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:87 MEDICAL PARK DR STE A
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3210
Practice Address - Country:US
Practice Address - Phone:828-883-5858
Practice Address - Fax:828-884-3339
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149607208800000X
AL16266208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000038675Medicaid
AL51038675OtherBCBS - GUNTERSVILLE
AL000038673Medicaid
AL1910145OtherUNITED HEALTHCARE
AL51038673OtherBCBS - BOAZ
AL4303389OtherAETNA
AL000038673Medicaid
NCNCW221AMedicare UPIN
AL000038675Medicare ID - Type UnspecifiedMEDICARE - GUNTERSVILLE
AL1910145OtherUNITED HEALTHCARE
AL1539761Medicare ID - Type UnspecifiedUMWA H&R FUNDS
AL000038673Medicare ID - Type UnspecifiedMEDICARE - BOAZ