MEDICARE: JOE DAN METCALF 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	261QA1903X	Ambulatory Surgical Clinic/Center	8629	OK

General Provider Information

NPI Number	:	1467659250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE DAN METCALF M.D.

Provider Business Mailing Address
First Line	:	12400 SAINT ANDREWS DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8601
Country	:	US
Telephone Number	:	405-751-0042
Fax Number	:	405-751-0205

Provider Business Practice Location Address
First Line	:	12400 SAINT ANDREWS DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8601
Country	:	US
Telephone Number	:	405-751-0042
Fax Number	:	405-751-0205

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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