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NPI Code Detail

MEDICARE: JAMES G PRISE MD

MEDICARE: JAMES G PRISE 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
1207Q00000XFamily Medicine Physician19402OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932134806
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES G PRISE MD
Provider Business Mailing Address
First Line : PO BOX 269064
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73126-9064
Country : US
Telephone Number : 405-231-3857
Fax Number : 405-272-7977
Provider Business Practice Location Address
First Line : 781 GRAND CASINO BLVD
Second Line :
City : SHAWNEE
State : OK
Zip : 74804-1005
Country : US
Telephone Number : 405-964-5770
Fax Number : 405-964-5783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/13/2015

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