Individual
THADDEUS COX CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1340 BROAD AVE, SUITE 210, GULFPORT, MS 39501-2418
(228) 863-4490
(228) 863-7238
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 863-4490
(228) 863-7238
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
08995
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019775
—
MS
Enumeration date
07/13/2005
Last updated
07/10/2014
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