Individual
MR. RICHARD CAROLINA III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4109 NW 59TH STREET, OKLAHOMA CITY, OK 73112
(405) 924-9972
Mailing address
4109 NW 59TH STREET, OKLAHOMA CITY, OK 73112
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
09/13/2012
Last updated
09/28/2012
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