MEDICARE: DR. CHARLES C CARTER MD DPH PLLC

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
1	207Q00000X	Family Medicine Physician	19154	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	300522327	OTHER	OK	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C-8500	OTHER	AR	ARKANSAS STATE LICENSE #
2	19154	OTHER	OK	OK STATE LICENSE #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730129750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES C CARTER MD DPH PLLC

Provider Business Mailing Address
First Line	:	PO BOX 575
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73522-0575
Country	:	US
Telephone Number	:	580-480-1600
Fax Number	:	580-480-1601

Provider Business Practice Location Address
First Line	:	1015 E BROADWAY ST STE 102
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-5506
Country	:	US
Telephone Number	:	580-480-1600
Fax Number	:	580-480-1601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/16/2021

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Directions to “ DR. CHARLES C CARTER MD DPH PLLC” Practice Location

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