Healthcare Provider Details

I. General information

NPI: 1023965902
Provider Name (Legal Business Name): CARTER DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S PARK LN STE 330
ALTUS OK
73521-5755
US

IV. Provider business mailing address

205 S PARK LN STE 330
ALTUS OK
73521-5755
US

V. Phone/Fax

Practice location:
  • Phone: 580-576-3376
  • Fax: 580-576-3375
Mailing address:
  • Phone: 580-576-3376
  • Fax: 580-576-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: WESTLEY ALAN CARTER
Title or Position: PHYSICIAN
Credential:
Phone: 580-576-3376