Provider Demographics
NPI:1265428676
Name:CARTER, PETER WHITNEY (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:WHITNEY
Last Name:CARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6029 WALNUT GROVE RD STE 301
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-747-9081
Practice Address - Fax:901-747-9087
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5308207RH0003X
MS21269207RH0003X
TNMD15578207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1189425OtherUNITED HEALTHCARE
TN4136089OtherBCBS
MS08607087Medicaid
AR5F008OtherAR BCBS GROUP
TN3047008Medicaid
AR163638001Medicaid
TN4227737OtherBCBS TN
MO507326106OtherMO MEDICAID GROUP
TNP00390066OtherRAIL ROAD MEDICARE
MO209898808Medicaid
AR1265428676OtherBCBS AR
4202653OtherAETNA
AR5N810Medicaid
AR154259002OtherAR MEDICAID GROUP
TNDB2406OtherRAIL ROAD MEDICARE GROUP
TN3047000Medicaid
TN4136089OtherBCBS
TNP00390066OtherRAIL ROAD MEDICARE
MS08607087Medicaid
MS$$$$$$$$$OtherBCBS OF MS
MS$$$$$$$$$OtherBCBS MS
MS08607087Medicaid