Healthcare Provider Details

I. General information

NPI: 1053401604
Provider Name (Legal Business Name): MICHAEL O'QUIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 N VAN BUREN ST SUITE 300
ENID OK
73703-1812
US

IV. Provider business mailing address

PO BOX 3494
ENID OK
73702-3494
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-7070
  • Fax:
Mailing address:
  • Phone: 580-234-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16476
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: