Healthcare Provider Details

I. General information

NPI: 1306983218
Provider Name (Legal Business Name): MARCUS JAMES FIDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MORRIS DR
OKMULGEE OK
74447-6429
US

IV. Provider business mailing address

1401 MORRIS DR
OKMULGEE OK
74447-6429
US

V. Phone/Fax

Practice location:
  • Phone: 918-756-4233
  • Fax:
Mailing address:
  • Phone: 918-756-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number24062
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: