MEDICARE: DR. PATRICIA INGHAM OVERHULSER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	17776	OK

General Provider Information

NPI Number	:	1053318162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA INGHAM OVERHULSER M.D.

Provider Business Mailing Address
First Line	:	750 NE 13TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5010
Country	:	US
Telephone Number	:	405-235-0040
Fax Number	:	405-235-4495

Provider Business Practice Location Address
First Line	:	750 NE 13TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5010
Country	:	US
Telephone Number	:	405-235-0040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	05/20/2009

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