Provider Demographics
NPI:1174512370
Name:CARTER, GINA RENEE (DO)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:RENEE
Last Name:CARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:940 EXECUTIVE DR
Mailing Address - Street 2:LAKE CBOC-VA
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3497
Mailing Address - Country:US
Mailing Address - Phone:573-302-7890
Mailing Address - Fax:573-302-7974
Practice Address - Street 1:940 EXECUTIVE DR
Practice Address - Street 2:LAKE CBOC-VA
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3497
Practice Address - Country:US
Practice Address - Phone:573-302-7890
Practice Address - Fax:573-302-7974
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MODO-R1HO4207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine