Healthcare Provider Details

I. General information

NPI: 1043496409
Provider Name (Legal Business Name): JOHN ANDREW MAUPIN JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 NW 57TH ST
OKLAHOMA CITY OK
73118-5905
US

IV. Provider business mailing address

705 NW 57TH ST
OKLAHOMA CITY OK
73118-5905
US

V. Phone/Fax

Practice location:
  • Phone: 405-550-0060
  • Fax:
Mailing address:
  • Phone: 405-550-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO 3286
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: