Basic Information
| Provider Information | |||||||||
| NPI: | 1689758021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | CARROL | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 N INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731061810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053605600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1776 E ROBINSON ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730717442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053605600 | ||||||||
| FaxNumber: | 4053604963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA595 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.