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General NPI Number Information
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NPI Number | 1114126976
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Entity Type | Organization
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Legal Business Name | DWAYNE H ATWELL MD PC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 251 SOUTH 37TH STREET
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City | MUSKOGEE
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State | OK
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Zip | 74401-4919
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Country | US
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Telephone | 918-683-0121
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Fax | 918-683-6650
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Provider Business Mailing Address
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Address Line | 251 SOUTH 37TH STREET
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City | MUSKOGEE
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State | OK
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Zip | 74401-4919
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Country | US
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Telephone | 918-683-0121
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Fax | 918-683-6650
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Authorized Official
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Title or Position | INSURANCE CLERK
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Name | MRS. BRANDI L JONES
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Credential |
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Telephone | 918-683-0121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 16851
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License Number State | OK
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