Healthcare Provider Details

I. General information

NPI: 1356693048
Provider Name (Legal Business Name): ARVEITTA YVONNE EDGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W BROADWAY ST
SPIRO OK
74959-2430
US

IV. Provider business mailing address

702 W BROADWAY ST
SPIRO OK
74959-2430
US

V. Phone/Fax

Practice location:
  • Phone: 918-962-2442
  • Fax: 918-962-3895
Mailing address:
  • Phone: 918-962-2442
  • Fax: 918-962-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31713
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: