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NPI Code Detail

MEDICARE: ERICA R. SUN D.O.

MEDICARE: ERICA R. SUN D.O.
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
1207Q00000XFamily Medicine Physician34-008767OH
22084P0800XPsychiatry Physician34-008767OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136123OTHEROKOBNDD LICENSE
24562OTHEROKLICENSE

General Provider Information

NPI Number : 1689693467
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA R. SUN D.O.
Provider Business Mailing Address
First Line : 527 W 3RD ST
Second Line :
City : KONAWA
State : OK
Zip : 74849-1415
Country : US
Telephone Number : 580-925-3286
Fax Number : 580-421-6283
Provider Business Practice Location Address
First Line : 905 COLONY DR
Second Line :
City : ADA
State : OK
Zip : 74820-2329
Country : US
Telephone Number : 580-436-5111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 03/07/2023

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Directions to “ ERICA R. SUN D.O.” Practice Location

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