Provider Demographics
NPI:1417050626
Name:EGAS, CARLOS ADRIAN (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ADRIAN
Last Name:EGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:EGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2801 PARKLAWN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4230
Mailing Address - Country:US
Mailing Address - Phone:405-610-2400
Mailing Address - Fax:405-610-2411
Practice Address - Street 1:2801 PARKLAWN DR STE 300
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4230
Practice Address - Country:US
Practice Address - Phone:405-610-2400
Practice Address - Fax:405-610-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25177208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery