Provider Demographics
NPI:1124108378
Name:CARY CARPENTER, M.D. P.C.
Entity type:Organization
Organization Name:CARY CARPENTER, M.D. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-808-7765
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-0010
Mailing Address - Country:US
Mailing Address - Phone:405-390-9600
Mailing Address - Fax:405-390-9400
Practice Address - Street 1:15809 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8428
Practice Address - Country:US
Practice Address - Phone:405-390-9600
Practice Address - Fax:405-390-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00757OtherMEDICARE UPIN - BRUCE STAFFORD, D.O.
OK200100040AMedicaid
249341123OtherMEDICARE INDIVIDUAL P-TAN - CARY CARPENTER M.D.
1861479255OtherNPI - BRUCE STAFFORD, D.O.
241409404OtherMEDICARE INDIVIDUAL P-TAN FOR BRUCE STAFFORD, D.O.
OK44646OtherBLUE LINCS - BRUCE STAFFORD, DO
1053311548OtherNPI - CARY CARPENTER M.D.
1164597860OtherNPI - PHYSICIAN ASSISTANT BILLY SANDERS
OK446-46-7483-001OtherBCBS-BRUCE STAFFORD, DO
900522085OtherMEDICARE GROUP P-TAN --CARY CARPENTER MD PC DBA CHOCTAW FAMILY MEDICINE
OK100113820EMedicaid
OK1861479255OtherNPI-BRUCE STAFFORD, DO -
OK444745244-001OtherCARY CARPENTER -BCBS
OK100113820BMedicaid
F43282OtherMEDICARE UPIN - CARY CARPENTER M.D.
OK100113820DMedicaid
OK44646OtherBLUE LINCS - BRUCE STAFFORD, DO
OK100113820DMedicaid
OK249341123Medicare PIN
1053311548OtherNPI - CARY CARPENTER M.D.
1164597860OtherNPI - PHYSICIAN ASSISTANT BILLY SANDERS
OK100122850BMedicaid