MEDICARE: MATTHEW HART

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	207Q00000X	Family Medicine Physician	39542	OK

General Provider Information

NPI Number	:	1679175764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW HART

Provider Business Mailing Address
First Line	:	940 STANTON L YOUNG BLVD # 357
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14025 N EASTERN AVE APT 2912
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3520
Country	:	US
Telephone Number	:	405-881-6737
Fax Number	:

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

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	04/07/2026

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Directions to “ MATTHEW HART ” Practice Location

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