Healthcare Provider Details

I. General information

NPI: 1528094653
Provider Name (Legal Business Name): WILLIAM MARSHALL OHL P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W IOWA AVE
CHICKASHA OK
73018-2736
US

IV. Provider business mailing address

2100 W IOWA AVE
CHICKASHA OK
73018-2736
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-2100
  • Fax: 405-779-2808
Mailing address:
  • Phone: 405-224-2100
  • Fax: 405-779-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number112
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: