MEDICARE: DR. ROYICE BERT EVERETT 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	207VG0400X	Gynecology Physician	10054	OK

General Provider Information

NPI Number	:	1235137191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROYICE BERT EVERETT M.D.

Provider Business Mailing Address
First Line	:	3366 NW EXPRESSWAY
Second Line	:	SUITE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4462
Country	:	US
Telephone Number	:	405-942-5593
Fax Number	:	405-942-5794

Provider Business Practice Location Address
First Line	:	3366 NW EXPRESSWAY
Second Line	:	SUITE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4462
Country	:	US
Telephone Number	:	405-942-5593
Fax Number	:	405-942-5794

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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