Provider Demographics
NPI:1144320391
Name:CARTER, DUANE LEE (MSC,CRC)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:LEE
Last Name:CARTER
Suffix:
Gender:M
Credentials:MSC,CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 S WESTERN AVE
Mailing Address - Street 2:APT. 1905
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6900
Mailing Address - Country:US
Mailing Address - Phone:405-401-3249
Mailing Address - Fax:405-290-1777
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-270-0501
Practice Address - Fax:405-290-1777
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK93052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist