Provider Demographics
NPI:1063444537
Name:DENNIS J CARTER DO PC
Entity Type:Organization
Organization Name:DENNIS J CARTER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-647-2929
Mailing Address - Street 1:PO BOX 1055
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1055
Mailing Address - Country:US
Mailing Address - Phone:918-647-2929
Mailing Address - Fax:918-647-2288
Practice Address - Street 1:1013 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4409
Practice Address - Country:US
Practice Address - Phone:918-647-2929
Practice Address - Fax:918-647-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR8P193OtherARKANSAS BLUE CROSS BLUE SHIELD
DF2722OtherRAILROAD MEDICARE
OK200085280AMedicaid
OK200085280AMedicaid
OK=========001OtherBLUE CROSS BLUE SHIELD OKLAHOMA