MEDICARE: DR. MARCUS JAMES FIDEL 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	2084P0800X	Psychiatry Physician	24062	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24062	OTHER	OK	OK STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1306983218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS JAMES FIDEL MD

Provider Business Mailing Address
First Line	:	1401 MORRIS DR
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6429
Country	:	US
Telephone Number	:	918-756-4233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 MORRIS DR
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6429
Country	:	US
Telephone Number	:	918-756-4233
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	10/08/2025

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