Healthcare Provider Details

I. General information

NPI: 1760564363
Provider Name (Legal Business Name): PATRICK SEAN MYER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N DEWEY AVE
OKLAHOMA CITY OK
73103-2609
US

IV. Provider business mailing address

2204 MORNING STAR
EDMOND OK
73034-6574
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-9671
  • Fax:
Mailing address:
  • Phone: 405-696-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166931
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN205132
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number110507
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: