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General NPI Number Information
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NPI Number | 1154647386
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Entity Type | Individual
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Provider Name | KORBY ALLEN POGUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 4502 E 41ST ST
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City | TULSA
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State | OK
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Zip | 74135-9923
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Country | US
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Telephone | 405-517-4820
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Fax |
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Provider Business Mailing Address
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Address Line | 827 LEGACY FARM RD
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City | CHESTNUTRIDGE
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State | MO
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Zip | 65630-3100
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Country | US
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Telephone | 405-517-4820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2016023007
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License Number State | MO
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