Provider Demographics
NPI:1659347391
Name:CAREY, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:CAREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 610
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-286-9465
Mailing Address - Fax:405-286-9462
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:STE 4005
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-632-4252
Practice Address - Fax:405-632-6166
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100111030AMedicaid
OK100111030AMedicaid
OK100111030AMedicaid
OK$$$$$$$$$005OtherBC/BS
OKE11709Medicare UPIN