1891792040 NPI number — DR. DON ALAN CARNAHAN M.D.

Table of content: DR. DON ALAN CARNAHAN M.D. (NPI 1891792040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891792040 NPI number — DR. DON ALAN CARNAHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNAHAN
Provider First Name:
DON
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891792040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 N INDEPENDENCE AVE
Provider Second Line Business Mailing Address:
280
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-5556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-540-7753
Provider Business Mailing Address Fax Number:
918-540-7709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 2ND AVE SW
Provider Second Line Business Practice Location Address:
STE 106-A
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74354-6743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-540-7753
Provider Business Practice Location Address Fax Number:
918-540-7709
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  19510 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200462050R , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100080340A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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