Healthcare Provider Details

I. General information

NPI: 1003881921
Provider Name (Legal Business Name): MIGUEL RAY SABEDRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 4TH ST
MARLOW OK
73055-1807
US

IV. Provider business mailing address

501N 4TH ST
MARLOW OK
73055-1807
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-6679
  • Fax: 580-658-8021
Mailing address:
  • Phone: 580-658-3203
  • Fax: 580-658-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17353
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: