Provider Demographics
NPI:1871990374
Name:MCCART, ERIC DEAN
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DEAN
Last Name:MCCART
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:PO BOX 403
Mailing Address - Street 2:116 WEST ASH
Mailing Address - City:POND CREEK
Mailing Address - State:OK
Mailing Address - Zip Code:73766-0403
Mailing Address - Country:US
Mailing Address - Phone:580-984-2795
Mailing Address - Fax:
Practice Address - Street 1:10501 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5790
Practice Address - Country:US
Practice Address - Phone:580-984-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant