Healthcare Provider Details

I. General information

NPI: 1063444537
Provider Name (Legal Business Name): DENNIS J CARTER DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 DEWEY AVE
POTEAU OK
74953-4409
US

IV. Provider business mailing address

PO BOX 1055
POTEAU OK
74953-1055
US

V. Phone/Fax

Practice location:
  • Phone: 918-647-2929
  • Fax: 918-647-2288
Mailing address:
  • Phone: 918-647-2929
  • Fax: 918-647-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2689
License Number StateOK

VIII. Authorized Official

Name: DENNIS J CARTER
Title or Position: OWNER
Credential: D.O.
Phone: 918-647-2929