Provider Demographics
NPI:1750428603
Name:HARP-WETZ, CARRIE (DO)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:HARP-WETZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 715
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-4750
Mailing Address - Fax:918-481-4755
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 715
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-4750
Practice Address - Fax:918-481-4755
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200204280AMedicaid