Healthcare Provider Details

I. General information

NPI: 1235717802
Provider Name (Legal Business Name): CHRISTOPHER CARSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 RENAISSANCE BLVD
EDMOND OK
73013-3086
US

IV. Provider business mailing address

730 W MARKET ST
LIMA OH
45801-4602
US

V. Phone/Fax

Practice location:
  • Phone: 405-844-4978
  • Fax: 405-844-0562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43933
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: