Healthcare Provider Details

I. General information

NPI: 1619098753
Provider Name (Legal Business Name): MARLOW PHYSICIANS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 4TH ST
MARLOW OK
73055-1807
US

IV. Provider business mailing address

501 N 4TH ST
MARLOW OK
73055-1807
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-3203
  • Fax: 580-658-6960
Mailing address:
  • Phone: 580-658-3203
  • Fax: 580-658-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUG MORROW
Title or Position: CREDENTIALING SPEC
Credential:
Phone: 580-475-0175