Individual
MARY M CARTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 294-7444
Mailing address
PO BOX 11219, FORT WORTH, TX 76110-0219
(817) 294-7444
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA00165
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005LF
BCBS
TX
Enumeration date
10/25/2006
Last updated
07/08/2007
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