Healthcare Provider Details

I. General information

NPI: 1265329940
Provider Name (Legal Business Name): CARSON WONDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NE 13TH ST
OKLAHOMA CITY OK
73104-5008
US

IV. Provider business mailing address

940 NE 13TH ST
OKLAHOMA CITY OK
73104-5008
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5125
  • Fax:
Mailing address:
  • Phone: 405-271-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47791
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: