Healthcare Provider Details

I. General information

NPI: 1790747293
Provider Name (Legal Business Name): JAMES S ARCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N SHARTEL AVE SUITE 300
OKLAHOMA CITY OK
73103-2400
US

IV. Provider business mailing address

1211 S SHARTEL AVE SUITE 300
OKLAHOMA CITY OK
73170
US

V. Phone/Fax

Practice location:
  • Phone: 405-235-8008
  • Fax: 405-239-2403
Mailing address:
  • Phone: 405-235-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13089
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: