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Individual

BLAKE WALKER CARTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(918) 582-1972
Mailing address
412 SW 145TH ST, OKLAHOMA CITY, OK 73170-7298

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
10/04/2023
Last updated
10/04/2023
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