Individual
THADDEUS ALAN CARNINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2017 W I 35 FRONTAGE RD STE 250, EDMOND, OK 73013-8561
(405) 757-3340
(405) 757-3520
Mailing address
2017 W I 35 FRONTAGE RD STE 250, EDMOND, OK 73013-8561
(405) 757-3340
(405) 757-3520
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22939
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200166750A
—
OK
Enumeration date
09/05/2006
Last updated
03/29/2018
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