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NPI Code Detail

MEDICARE: DR. GEORGE J CARSTENS III M.D.

MEDICARE: DR. GEORGE J CARSTENS III M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician20153OK

General Provider Information

NPI Number : 1104813799
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE J CARSTENS III M.D.
Provider Business Mailing Address
First Line : 6117 S MARION AVE
Second Line :
City : TULSA
State : OK
Zip : 74136-1506
Country : US
Telephone Number : 918-524-0056
Fax Number :
Provider Business Practice Location Address
First Line : 6901 S OLYMPIA AVE
Second Line :
City : TULSA
State : OK
Zip : 74132-1843
Country : US
Telephone Number : 918-388-5701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 07/08/2007

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