Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 10850 | OK |
NPI | 1033163100 |
---|---|
Provider Name | John S. Muchmore |
First Address | Oklahoma City, OK 73112-5556 |
Second Address | Oklahoma City, OK 73112-2131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2006 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100116630B | (05) | OK |
C95271 | (02) |