MEDICARE: MAURICE ERNEST CORMAN M D PLLC

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	207Q00000X	Family Medicine Physician	23210	OK

General Provider Information

NPI Number	:	1144233867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAURICE ERNEST CORMAN M D PLLC

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE #141; ATTN: BECKY
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-936-5811
Fax Number	:	405-936-5810

Provider Business Practice Location Address
First Line	:	63 GOODER SIMPSON BLVD.
Second Line	:
City	:	PIEDMONT
State	:	OK
Zip	:	73078
Country	:	US
Telephone Number	:	405-373-0380
Fax Number	:	405-373-0457

Authorized Official
Title or Position	:	OWNER
Name	:	MAURICE E. CORMAN
Credential	:	M.D.
Telephone Number	:	405-373-0375

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	11/11/2007

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