Healthcare Provider Details

I. General information

NPI: 1619372026
Provider Name (Legal Business Name): CAGR MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 S WALKER AVE
OKLAHOMA CITY OK
73139-9449
US

IV. Provider business mailing address

8315 S WALKER AVE
OKLAHOMA CITY OK
73139-9449
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-1506
  • Fax: 405-636-1511
Mailing address:
  • Phone: 405-636-1506
  • Fax: 405-636-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number21472
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number21472
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number21472
License Number StateOK

VIII. Authorized Official

Name: CARRIE KRAPFF
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-636-1506