MEDICARE: DR. GREGG STANLEY GOVETT 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	207Y00000X	Otolaryngology Physician	19438	OK

General Provider Information

NPI Number	:	1093717704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG STANLEY GOVETT M.D.

Provider Business Mailing Address
First Line	:	1205 S AIR DEPOT BLVD
Second Line	:	131
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4807
Country	:	US
Telephone Number	:	405-732-3755
Fax Number	:	405-733-1784

Provider Business Practice Location Address
First Line	:	1201 S. POST RD.
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130
Country	:	US
Telephone Number	:	405-732-3755
Fax Number	:	405-733-1784

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/03/2008

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