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General NPI Number Information
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NPI Number | 1497672786
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Entity Type | Individual
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Provider Name | COLTON CARLSON
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Gender |
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 920 STANTON L YOUNG BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5020
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Country | US
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Telephone | 405-271-4113
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Fax |
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Provider Business Mailing Address
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Address Line | 14554 NE 50TH ST
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City | CHOCTAW
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State | OK
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Zip | 73020-9522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 50015
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License Number State | OK
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