Healthcare Provider Details

I. General information

NPI: 1104967389
Provider Name (Legal Business Name): HENRY J PEARCE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR
EDMOND OK
73034-6357
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR
EDMOND OK
73034-6357
US

V. Phone/Fax

Practice location:
  • Phone: 405-340-0511
  • Fax: 405-348-9026
Mailing address:
  • Phone: 405-340-0511
  • Fax: 405-348-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number8341
License Number StateOK

VIII. Authorized Official

Name: HENRY J PEARCE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-340-0511