Provider Demographics
NPI:1093573941
Name:CARTER, SAM SR
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:CARTER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1917
Mailing Address - Country:US
Mailing Address - Phone:405-979-3900
Mailing Address - Fax:
Practice Address - Street 1:501 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-1917
Practice Address - Country:US
Practice Address - Phone:405-979-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist