Healthcare Provider Details

I. General information

NPI: 1881682839
Provider Name (Legal Business Name): CARL MARTIN LINDQUIST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 AMDS/SGPO 8941 ENTRANCE RD A BLD 3334
TINKER AFB OK
73145-3065
US

IV. Provider business mailing address

7050 AIR DEPOT BLVD
TINKER AFB OK
73145-8716
US

V. Phone/Fax

Practice location:
  • Phone: 405-582-6805
  • Fax: 405-734-3404
Mailing address:
  • Phone: 405-582-6805
  • Fax: 405-734-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-62761
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-062761
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number5303
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: