Healthcare Provider Details

I. General information

NPI: 1881686186
Provider Name (Legal Business Name): MARCUS D SIZEMORE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 5TH
BARNSDALL OK
74002
US

IV. Provider business mailing address

112 N 5TH
BARNSDALL OK
74002
US

V. Phone/Fax

Practice location:
  • Phone: 918-847-2558
  • Fax: 918-847-2053
Mailing address:
  • Phone: 918-847-2558
  • Fax: 918-847-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number305
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: