Provider Demographics
NPI:1265427140
Name:COUCH, CARY
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:
Last Name:COUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5513
Mailing Address - Country:US
Mailing Address - Phone:405-707-7500
Mailing Address - Fax:405-742-4990
Practice Address - Street 1:320 N PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5513
Practice Address - Country:US
Practice Address - Phone:405-707-7500
Practice Address - Fax:405-742-4990
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9237207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34547Medicare UPIN