Healthcare Provider Details

I. General information

NPI: 1699081786
Provider Name (Legal Business Name): CECIL EMERY MCCURDY JR. MED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 S OLIE AVE UNIT 5
OKLAHOMA CITY OK
73139-9359
US

IV. Provider business mailing address

8801 S OLIE AVE UNIT 5
OKLAHOMA CITY OK
73139-9359
US

V. Phone/Fax

Practice location:
  • Phone: 405-616-2442
  • Fax:
Mailing address:
  • Phone: 405-616-2442
  • Fax: 405-616-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: