MEDICARE: DANIEL E OATHOUT MD

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	13020	OK

General Provider Information

NPI Number	:	1720087869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL E OATHOUT MD

Provider Business Mailing Address
First Line	:	PO BOX 960219
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73196-0001
Country	:	US
Telephone Number	:	580-548-1367
Fax Number	:	580-548-1537

Provider Business Practice Location Address
First Line	:	620 S MADISON ST
Second Line	:	SUITE 301
City	:	ENID
State	:	OK
Zip	:	73701-7270
Country	:	US
Telephone Number	:	580-233-6350
Fax Number	:	580-233-6106

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/27/2007

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