Individual
MR. PRENTISS BERNARD CARTER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 308, PEORIA, IL 61614-5098
(309) 692-5100
(309) 692-1400
Mailing address
5401 N KNOXVILLE AVE, SUITE 308, PEORIA, IL 61614-5098
(309) 692-5100
(309) 692-1400
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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