Healthcare Provider Details

I. General information

NPI: 1811942345
Provider Name (Legal Business Name): ANGELA SELMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S TELEPHONE ROAD
MOORE OK
73160
US

IV. Provider business mailing address

2612 NW 152ND ST
EDMOND OK
73013
US

V. Phone/Fax

Practice location:
  • Phone: 405-793-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number17207
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17207
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: