Healthcare Provider Details

I. General information

NPI: 1417928839
Provider Name (Legal Business Name): ROGER A MUELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 MEMORIAL CIR
OKLAHOMA CITY OK
73142-5004
US

IV. Provider business mailing address

4505 MEMORIAL CIR
OKLAHOMA CITY OK
73142-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-1880
  • Fax: 405-755-9237
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9596
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: