Healthcare Provider Details

I. General information

NPI: 1831349281
Provider Name (Legal Business Name): SUSANNAH L COLLIER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 W MEMORIAL RD SUITE 101
OKLAHOMA CITY OK
73134-1512
US

IV. Provider business mailing address

3705 W MEMORIAL RD SUITE 101
OKLAHOMA CITY OK
73134-1512
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-0020
  • Fax: 405-751-0009
Mailing address:
  • Phone: 405-751-0020
  • Fax: 405-751-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number24822
License Number StateOK

VIII. Authorized Official

Name: SUSANNAH L COLLIER
Title or Position: MANAGER
Credential: MD
Phone: 405-751-0020