Provider Demographics
NPI:1861990665
Name:CLINE, CARLTON
Entity type:Individual
Prefix:
First Name:CARLTON
Middle Name:
Last Name:CLINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 W HILTON RD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-1123
Mailing Address - Country:US
Mailing Address - Phone:918-695-4835
Mailing Address - Fax:
Practice Address - Street 1:5022 W HILTON RD
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-1123
Practice Address - Country:US
Practice Address - Phone:918-695-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200514400AMedicaid