Provider Demographics
NPI:1992762272
Name:CANDLER, CARISSA TEMPLE (MD)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:TEMPLE
Last Name:CANDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:120 N BRYANT AVE
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6302
Mailing Address - Country:US
Mailing Address - Phone:405-285-8172
Mailing Address - Fax:405-285-8174
Practice Address - Street 1:120 N BRYANT AVE
Practice Address - Street 2:SUITE A-6
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6302
Practice Address - Country:US
Practice Address - Phone:405-285-8172
Practice Address - Fax:405-285-8174
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK207742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK2008326014Medicare UPIN