Healthcare Provider Details
I. General information
NPI: 1083659635
Provider Name (Legal Business Name): TODD K POGUE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/18/2006
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1325 E BOONE ST
TAHLEQUAH OK
74464-3361
US
IV. Provider business mailing address
1325 E BOONE ST
TAHLEQUAH OK
74464-3361
US
V. Phone/Fax
- Phone: 918-207-4977
- Fax:
- Phone: 918-207-4977
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | CL0056 |
| License Number State | NV |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | DO-03788 |
| License Number State | IA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | MED-PHYS-LIC-78691 |
| License Number State | MT |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | OC-0046 |
| License Number State | ID |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 27016 |
| License Number State | MS |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 66313 |
| License Number State | MN |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 15992 |
| License Number State | ND |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 19988 |
| License Number State | NH |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 3863 |
| License Number State | TN |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 11452352-1204 |
| License Number State | UT |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 2098 |
| License Number State | NE |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 05-42575 |
| License Number State | KS |
| # 13 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 4110 |
| License Number State | OK |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | H88263 |
| License Number State | MD |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | M8922 |
| License Number State | TX |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
