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General NPI Number Information
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NPI Number | 1649217191
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Entity Type | Individual
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Provider Name | JOHN P AGENT DO
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 1015 E CHOCTAW AVE
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City | SALLISAW
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State | OK
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Zip | 74955-5011
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Country | US
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Telephone | 918-774-0034
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Fax | 918-774-0650
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Provider Business Mailing Address
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Address Line | PO BOX 776075
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City | CHICAGO
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State | IL
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Zip | 60677-6075
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Country | US
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Telephone | 918-774-0034
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-1152
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3341
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License Number State | OK
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