Provider Demographics
NPI:1689669111
Name:PAINTER, CARL F III (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:F
Last Name:PAINTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:PAINTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:725 SAINT FRANCIS WAY
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1780
Mailing Address - Country:US
Mailing Address - Phone:217-324-8798
Mailing Address - Fax:217-324-8622
Practice Address - Street 1:4140 SE ADAMS RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-331-1653
Practice Address - Fax:918-331-1645
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21533207X00000X
IL036101536207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100192510AMedicaid
H19641Medicare UPIN
248327501Medicare ID - Type Unspecified