Provider Demographics
NPI:1740626365
Name:CARISSA CANDLER MD PLLC
Entity type:Organization
Organization Name:CARISSA CANDLER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-285-8172
Mailing Address - Street 1:120 N BRYANT AVE
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6302
Mailing Address - Country:US
Mailing Address - Phone:405-285-8172
Mailing Address - Fax:405-285-8174
Practice Address - Street 1:120 N BRYANT AVE
Practice Address - Street 2:SUITE A-6
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6302
Practice Address - Country:US
Practice Address - Phone:405-285-8172
Practice Address - Fax:405-285-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty