Healthcare Provider Details

I. General information

NPI: 1922234491
Provider Name (Legal Business Name): J S RUTHERFORD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 W OKMULGEE ST
MUSKOGEE OK
74401-5069
US

IV. Provider business mailing address

4400 WILL ROGERS PKWY SUITE 105
OKLAHOMA CITY OK
73108-1837
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-2481
  • Fax: 918-682-2482
Mailing address:
  • Phone: 405-947-5557
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26821
License Number StateOK

VIII. Authorized Official

Name: DEBORAH NEAL
Title or Position: COORDINATOR
Credential:
Phone: 405-947-5557