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General NPI Number Information
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NPI Number | 1740626365
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Entity Type | Organization
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Legal Business Name | CARISSA CANDLER MD PLLC
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 120 N BRYANT AVE SUITE A-6
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City | EDMOND
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State | OK
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Zip | 73034-6302
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Country | US
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Telephone | 405-285-8172
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Fax | 405-285-8174
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Provider Business Mailing Address
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Address Line | 120 N BRYANT AVE SUITE A-6
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City | EDMOND
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State | OK
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Zip | 73034-6302
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Country | US
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Telephone | 405-285-8172
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Fax | 405-285-8174
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Authorized Official
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Title or Position | MD
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Name | CARISSA CANDLER
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Credential | MD
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Telephone | 405-285-8172
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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 |
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License Number State |
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