Healthcare Provider Details

I. General information

NPI: 1154398352
Provider Name (Legal Business Name): MIGY K MATHEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST VA MEDICAL CENTER-111-AC
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921NE 13 ST. VA MEDICAL CENTER-111 AC
OKLAHOMA CITY OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3050
  • Fax:
Mailing address:
  • Phone: 405-456-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21183
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number21183
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: