Healthcare Provider Details

I. General information

NPI: 1609802727
Provider Name (Legal Business Name): MARIE J. CARTER, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 S WESTERN AVE
OKLAHOMA CITY OK
73170-5819
US

IV. Provider business mailing address

PO BOX 890309
OKLAHOMA CITY OK
73189-0309
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-3041
  • Fax: 405-735-3146
Mailing address:
  • Phone: 405-631-3435
  • Fax: 405-632-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3450
License Number StateOK

VIII. Authorized Official

Name: DR. MARIE J. CARTER
Title or Position: PRESIDENT
Credential: DO
Phone: 405-631-3435