MEDICARE: MDPOK PHYSICIANS, P.C.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1508558594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDPOK PHYSICIANS, P.C.

Provider Business Mailing Address
First Line	:	119 S MAIN ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 S MORGAN RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-7004
Country	:	US
Telephone Number	:	314-609-3435
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	JOE MURRAY
Credential	:
Telephone Number	:	314-609-3435

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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