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General NPI Number Information
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NPI Number | 1447253141
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Entity Type | Individual
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Provider Name | MICHAEL L SOPER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 329 S 38TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4945
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Country | US
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Telephone | 918-687-9998
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Fax | 918-687-4135
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Provider Business Mailing Address
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Address Line | 329 S 38TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4945
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Country | US
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Telephone | 918-687-9998
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Fax | 918-687-4135
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 11682
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License Number State | OK
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