Individual
DR. CHARLES C CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD DPH PLLC
Contact information
Practice address
1015 E BROADWAY ST STE 102, ALTUS, OK 73521-5506
(580) 480-1600
(580) 480-1601
Mailing address
PO BOX 575, ALTUS, OK 73522-0575
(580) 480-1600
(580) 480-1601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19154
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100116810D
—
OK
05
—
10016810B
—
OK
01
—
19154
OK STATE LICENSE #
OK
01
—
300522327
MEDICARE GROUP PTAN
OK
01
—
C-8500
ARKANSAS STATE LICENSE #
AR
Enumeration date
06/07/2006
Last updated
09/16/2021
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