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Individual
MR. PRENTISS BERNARD CARTER III
Active
Individual
MR. PRENTISS BERNARD CARTER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036044919
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007215713
BLUE CROSS BLUE SHIELD
IL
05
—
036044919
—
IL
01
—
118779
HEALTHLINK
IL
Enumeration date
09/07/2006
Last updated
08/29/2011
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