Provider Demographics
NPI:1619372026
Name:CAGR MEDICAL, PLLC
Entity Type:Organization
Organization Name:CAGR MEDICAL, PLLC
Other - Org Name:SOUTHWESTERN DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAPFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-636-1506
Mailing Address - Street 1:8315 S WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9449
Mailing Address - Country:US
Mailing Address - Phone:405-636-1506
Mailing Address - Fax:405-636-1511
Practice Address - Street 1:8315 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9449
Practice Address - Country:US
Practice Address - Phone:405-636-1506
Practice Address - Fax:405-636-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21472207N00000X, 207ND0101X, 207NS0135X
207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty