Provider Demographics
NPI:1467502138
Name:PENCE, CARA DENISE (MD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:DENISE
Last Name:PENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:DENISE
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 W 6TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4376
Mailing Address - Country:US
Mailing Address - Phone:405-533-1074
Mailing Address - Fax:405-533-6074
Practice Address - Street 1:1301 W 6TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4376
Practice Address - Country:US
Practice Address - Phone:405-533-1074
Practice Address - Fax:405-533-6074
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK246730401Medicare PIN