=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447550827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY E. WEARE, M.D., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2010
-----------------------------------------------------
Last Update Date | 11/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S WYANDOTTE AVE
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74003-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-336-3277
-----------------------------------------------------
Fax | 918-336-0178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S WYANDOTTE AVE
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74003-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-336-3277
-----------------------------------------------------
Fax | 918-336-0178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARY E WEARE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 918-336-3277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 13446
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------