Provider Demographics
NPI:1336102532
Name:CARTER, DENNIS J (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:CARTER
Suffix:
Gender:M
Credentials:DO
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 1055
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1055
Mailing Address - Country:US
Mailing Address - Phone:918-647-2929
Mailing Address - Fax:918-647-2288
Practice Address - Street 1:1013 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4409
Practice Address - Country:US
Practice Address - Phone:918-647-2929
Practice Address - Fax:918-647-2288
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5572566OtherAETNA
OK100090700AMedicaid
OK100090700CMedicaid
OK010141300OtherBLACK LUNG
AR93023OtherBCBS OF ARKANSAS
5572566OtherAETNA
OK010141300OtherBLACK LUNG
AR93023OtherBCBS OF ARKANSAS