Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 17781 | OK |
NPI | 1043288673 |
---|---|
Provider Name | Dr. Craig W Carson |
First Address | Edmond, OK 73013-3084 |
Second Address | Edmond, OK 73013-3084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E41316 | (02) | OK |