Healthcare Provider Details

I. General information

NPI: 1124939947
Provider Name (Legal Business Name): MUSTANG FOOT & ANKLE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 INTEGRIS PKWY STE 300
EDMOND OK
73034-8696
US

IV. Provider business mailing address

551 N MUSTANG RD
MUSTANG OK
73064-7002
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-1115
  • Fax:
Mailing address:
  • Phone: 405-376-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW CARSON
Title or Position: OWNER
Credential: DPM
Phone: 405-326-2660