Healthcare Provider Details

I. General information

NPI: 1568458917
Provider Name (Legal Business Name): ERIC W. METHENY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MUSKOGEE PL
CLAREMORE OK
74017-3058
US

IV. Provider business mailing address

PO BOX 269024
OKLAHOMA CITY OK
73126-9024
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-2556
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number3973
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3973
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: