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NPI Code Detail

MEDICARE: MR. ROGERS WILLIAMS LOCHE III M.S.

MEDICARE: MR. ROGERS WILLIAMS LOCHE III M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)008911840LA

General Provider Information

NPI Number : 1457608036
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROGERS WILLIAMS LOCHE III M.S.
Provider Business Mailing Address
First Line : 3398 E 6TH AVE APT 405
Second Line :
City : STILLWATER
State : OK
Zip : 74074-6640
Country : US
Telephone Number : 318-214-7181
Fax Number :
Provider Business Practice Location Address
First Line : 3838 NW 36TH ST STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-2916
Country : US
Telephone Number : 405-702-9032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2012
Last Update Date : 08/13/2012

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