Healthcare Provider Details

I. General information

NPI: 1801896709
Provider Name (Legal Business Name): NOEL W. EMERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S VIRGINIA AVE
ATOKA OK
74525-3246
US

IV. Provider business mailing address

795 S BIG BEN RD
ATOKA OK
74525-4501
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-6621
  • Fax: 580-889-3602
Mailing address:
  • Phone: 580-889-6399
  • Fax: 580-889-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3521
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: