Provider Demographics
NPI:1942203575
Name:AGEE, CARSON KENDALL (MD)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:KENDALL
Last Name:AGEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-604-4224
Mailing Address - Fax:405-702-4734
Practice Address - Street 1:5401 N PORTLAND AVE STE 540
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2092
Practice Address - Country:US
Practice Address - Phone:405-604-4224
Practice Address - Fax:405-702-4734
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048474208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00866555AMedicaid
GAE60243Medicare UPIN
GA00866555AMedicaid