Healthcare Provider Details

I. General information

NPI: 1780752980
Provider Name (Legal Business Name): MERLIN JOE KILBURY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 2ND AVE SW
MIAMI OK
74354-6830
US

IV. Provider business mailing address

200 2ND AVE SW
MIAMI OK
74354-6830
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7573
  • Fax: 918-540-7590
Mailing address:
  • Phone: 918-540-7573
  • Fax: 918-540-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9907
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: