Healthcare Provider Details

I. General information

NPI: 1386970200
Provider Name (Legal Business Name): ARBUCKLE INTERNAL MEDICINE GROUP,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W 11TH ST STE 2
SULPHUR OK
73086-4459
US

IV. Provider business mailing address

921 W 11TH ST STE 2
SULPHUR OK
73086-4459
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-2353
  • Fax: 580-622-2351
Mailing address:
  • Phone: 580-622-2353
  • Fax: 580-622-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23001
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN OHENHEN
Title or Position: CEO
Credential: MD
Phone: 580-622-2353