Provider Demographics
NPI:1609802727
Name:MARIE J. CARTER, DO, PC
Entity type:Organization
Organization Name:MARIE J. CARTER, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-631-3435
Mailing Address - Street 1:PO BOX 890309
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-0309
Mailing Address - Country:US
Mailing Address - Phone:405-631-3435
Mailing Address - Fax:405-632-7416
Practice Address - Street 1:11401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5819
Practice Address - Country:US
Practice Address - Phone:405-735-3041
Practice Address - Fax:405-735-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3450208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200116430AMedicaid