Healthcare Provider Details

I. General information

NPI: 1982287082
Provider Name (Legal Business Name): CARSON SAGE MASRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 S WESTERN AVE STE 400
OKLAHOMA CITY OK
73139-1712
US

IV. Provider business mailing address

433 S LAHOMA AVE
NORMAN OK
73069-5523
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-1497
  • Fax:
Mailing address:
  • Phone: 918-978-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7890
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: