Organization
CARRISSA CANDLER MD PLLC
Active
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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