Provider Demographics
NPI:1083659635
Name:POGUE, TODD K (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:K
Last Name:POGUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1325 E BOONE ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3361
Mailing Address - Country:US
Mailing Address - Phone:918-207-4977
Mailing Address - Fax:
Practice Address - Street 1:1325 E BOONE ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3361
Practice Address - Country:US
Practice Address - Phone:918-207-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCL00562084P0800X
IADO-037882084P0800X
MTMED-PHYS-LIC-786912084P0800X
IDOC-00462084P0800X
MS270162084P0800X
MN663132084P0800X
ND159922084P0800X
NH199882084P0800X
TN38632084P0800X
UT11452352-12042084P0800X
NE20982084P0800X
KS05-425752084P0800X
OK41102084P0800X
MDH882632084P0800X
TXM89222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry