Healthcare Provider Details

I. General information

NPI: 1326095381
Provider Name (Legal Business Name): CHARLES C CARTER MD DPH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E BROADWAY ST SUITE 102
ALTUS OK
73521
US

IV. Provider business mailing address

PO BOX 575
ALTUS OK
73522-0575
US

V. Phone/Fax

Practice location:
  • Phone: 580-480-1600
  • Fax: 580-480-1601
Mailing address:
  • Phone: 580-480-1600
  • Fax: 580-480-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19154
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES C CARTER
Title or Position: OWNER PHYSICIAN
Credential: MD DPH
Phone: 580-480-1600