Provider Demographics
NPI:1699817205
Name:CARTER, MIRELA (MD)
Entity Type:Individual
Prefix:
First Name:MIRELA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6245
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-6245
Mailing Address - Country:US
Mailing Address - Phone:405-562-4221
Mailing Address - Fax:
Practice Address - Street 1:412 SE 11TH ST
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-4442
Practice Address - Country:US
Practice Address - Phone:405-247-9500
Practice Address - Fax:405-247-9505
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200131280AMedicaid
OK200131280AMedicaid