Healthcare Provider Details

I. General information

NPI: 1992996789
Provider Name (Legal Business Name): DOUGLAS MENZ, D.O. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20912 SE 29TH ST
HARRAH OK
73045-6439
US

IV. Provider business mailing address

20912 SE 29TH ST
HARRAH OK
73045-6439
US

V. Phone/Fax

Practice location:
  • Phone: 405-391-2970
  • Fax: 405-391-2972
Mailing address:
  • Phone: 405-391-2970
  • Fax: 405-391-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number3408
License Number StateOK

VIII. Authorized Official

Name: DR. GEORGE DOUGLAS MENZ
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 405-391-2970