MEDICARE: DR. JOHN WILLIAM ERVIN 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	207V00000X	Obstetrics & Gynecology Physician	33711	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	:	1629061213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILLIAM ERVIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 268838
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8838
Country	:	US
Telephone Number	:	918-660-8350
Fax Number	:	918-660-8355

Provider Business Practice Location Address
First Line	:	4444 E 41ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2527
Country	:	US
Telephone Number	:	918-619-4400
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	08/29/2018

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Directions to “ DR. JOHN WILLIAM ERVIN M.D.” Practice Location

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