MEDICARE: DR. DONGXU SUN M.D.

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
1	208M00000X	Hospitalist Physician	28082	OK
2	207R00000X	Internal Medicine Physician	N7972	TX
3	207R00000X	Internal Medicine Physician	28082	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	75-2616977-042	OTHER	TX	TRICARE
3	P01105249	OTHER	TX	RAIL ROAD
4	8DK100	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1538353149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONGXU SUN M.D.

Provider Business Mailing Address
First Line	:	1370 N INTERSTATE DR
Second Line	:	SUITE 154
City	:	NORMAN
State	:	OK
Zip	:	73072-3376
Country	:	US
Telephone Number	:	405-307-6668
Fax Number	:	405-701-6170

Provider Business Practice Location Address
First Line	:	2001 N JEFFERSON AVE
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2338
Country	:	US
Telephone Number	:	903-577-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	03/18/2019

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Directions to “ DR. DONGXU SUN M.D.” Practice Location

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