Healthcare Provider Details

I. General information

NPI: 1750313193
Provider Name (Legal Business Name): JOHN E. SEGUIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E MEMORIAL RD
OKLAHOMA CITY OK
73131-1253
US

IV. Provider business mailing address

1919 E MEMORIAL RD
OKLAHOMA CITY OK
73131-1253
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-7009
  • Fax: 405-330-1811
Mailing address:
  • Phone: 405-341-4009
  • Fax: 405-330-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19008
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: