Healthcare Provider Details

I. General information

NPI: 1699750554
Provider Name (Legal Business Name): J M HUSER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 LEGACY ST
WEATHERFORD OK
73096-5337
US

IV. Provider business mailing address

3725 LEGACY ST
WEATHERFORD OK
73096-5337
US

V. Phone/Fax

Practice location:
  • Phone: 580-772-3331
  • Fax: 580-774-1451
Mailing address:
  • Phone: 580-772-3331
  • Fax: 580-774-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17208
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: