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NPI Code Detail

MEDICARE: MR. MICHAEL WAYNE HERNDON DO

MEDICARE: MR. MICHAEL WAYNE HERNDON DO
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 Physician02371OK

General Provider Information

NPI Number : 1952350423
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL WAYNE HERNDON DO
Provider Business Mailing Address
First Line : 4545 N LINCOLN BOULEVARD
Second Line : SUITE #124
City : OKLAHOMA CITY
State : OK
Zip : 73105-3413
Country : US
Telephone Number : 405-522-7149
Fax Number : 405-530-3307
Provider Business Practice Location Address
First Line : 1919 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1253
Country : US
Telephone Number : 405-285-1180
Fax Number : 405-530-3307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/08/2007

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Directions to “ MR. MICHAEL WAYNE HERNDON DO” Practice Location

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