MEDICARE: ANTHONY AREVALOS MD

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	207R00000X	Internal Medicine Physician	R4F46	MO
2	207R00000X	Internal Medicine Physician	15416	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275562076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY AREVALOS MD

Provider Business Mailing Address
First Line	:	3400 S DOUGLAS BLVD
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1014
Country	:	US
Telephone Number	:	405-737-7000
Fax Number	:	405-272-2898

Provider Business Practice Location Address
First Line	:	3400 S DOUGLAS BLVD
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1014
Country	:	US
Telephone Number	:	405-737-7000
Fax Number	:	405-272-2898

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	11/01/2012

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Directions to “ ANTHONY AREVALOS MD” Practice Location

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