Healthcare Provider Details

I. General information

NPI: 1144495227
Provider Name (Legal Business Name): MICHAEL D. FURGESON, M. D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W VANDAMENT AVE SUITE 100
YUKON OK
73099-4655
US

IV. Provider business mailing address

508 W VANDAMENT AVE SUITE 100
YUKON OK
73099-4655
US

V. Phone/Fax

Practice location:
  • Phone: 405-350-8100
  • Fax: 405-350-6418
Mailing address:
  • Phone: 405-350-8100
  • Fax: 405-350-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number15287
License Number StateOK

VIII. Authorized Official

Name: DR. MICHAEL DOUGLAS FURGESON
Title or Position: OWNER
Credential: M. D.
Phone: 405-350-8100