Healthcare Provider Details

I. General information

NPI: 1538517842
Provider Name (Legal Business Name): SEAN REID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N 14TH ST STE 202B
PONCA CITY OK
74601-2039
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 580-713-4501
  • Fax: 580-718-4581
Mailing address:
  • Phone: 580-718-4501
  • Fax: 580-718-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number32405
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: