MEDICARE: PATRICK TIMOTHY PREVO M.D.

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	M8261	TX
2	208VP0014X	Interventional Pain Medicine Physician	29457	OK

General Provider Information

NPI Number	:	1972770386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK TIMOTHY PREVO M.D.

Provider Business Mailing Address
First Line	:	800 NW 9TH ST STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7253
Country	:	US
Telephone Number	:	405-231-2900
Fax Number	:	405-272-4905

Provider Business Practice Location Address
First Line	:	800 NW 9TH ST STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7253
Country	:	US
Telephone Number	:	405-231-2900
Fax Number	:	405-272-4905

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	04/15/2024

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