Healthcare Provider Details

I. General information

NPI: 1124108378
Provider Name (Legal Business Name): CARY CARPENTER, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15809 NE 23RD ST
CHOCTAW OK
73020-8428
US

IV. Provider business mailing address

PO BOX 10
CHOCTAW OK
73020-0010
US

V. Phone/Fax

Practice location:
  • Phone: 405-390-9600
  • Fax: 405-390-9400
Mailing address:
  • Phone: 405-390-9600
  • Fax: 405-390-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18237
License Number StateOK

VIII. Authorized Official

Name: MRS. LORRIE A CARPENTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-808-7765