Provider Demographics
NPI:1508894338
Name:CARTER, MARIE JUDITH (DO)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:JUDITH
Last Name:CARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5819
Mailing Address - Country:US
Mailing Address - Phone:405-735-3041
Mailing Address - Fax:405-735-3146
Practice Address - Street 1:11401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5819
Practice Address - Country:US
Practice Address - Phone:405-735-3041
Practice Address - Fax:405-735-3146
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3450208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100229790AMedicaid
OKP00132191OtherRAILROAD MEDICARE
OKH04749Medicare UPIN