Healthcare Provider Details

I. General information

NPI: 1043299258
Provider Name (Legal Business Name): MARY CAROLINE FIEBER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N. VAN BUREN
ENID OK
73703-1713
US

IV. Provider business mailing address

2609 N. VAN BUREN
ENID OK
73703-1713
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-0171
  • Fax: 580-237-0412
Mailing address:
  • Phone: 580-237-0171
  • Fax: 580-237-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberG62349
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number24212
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number24212
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG62349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: