Provider Demographics
NPI:1205878055
Name:CARTER, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:CARTER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:400 FAIRVIEW
Mailing Address - Street 2:SUITE 21
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-765-3356
Mailing Address - Fax:580-765-3353
Practice Address - Street 1:400 FAIRVIEW AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-765-3356
Practice Address - Fax:580-765-3353
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-05-29
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Provider Licenses
StateLicense IDTaxonomies
OK8690207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731007150001OtherBLUE CROSS/BLUE SHIELD
OK100116530AMedicaid
OKD38685Medicare UPIN
OK100116530AMedicaid