Organization
CARRISSA CANDLER MD PLLC
Active
Other names
Carissa Candler, MD
Organization subpart
No
Provider details
NPI number
Authorized official
CARRISSA CANDLER MD (MEDICAL DOCTOR)
(405) 936-0504
Entity
Organization
Contact information
Practice address
120 N BRYANT AVE STE A6, EDMOND, OK 73034-6300
(405) 936-0504
(405) 936-0561
Mailing address
120 N BRYANT AVE STE A6, EDMOND, OK 73034-6300
(405) 936-0504
(405) 936-0561
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
20774
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200166550A
—
OK
Enumeration date
08/15/2012
Last updated
08/15/2012
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