Provider Demographics
NPI:1114126976
Name:DWAYNE H ATWELL MD PC
Entity Type:Organization
Organization Name:DWAYNE H ATWELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-683-0121
Mailing Address - Street 1:251 SOUTH 37TH STREET
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4919
Mailing Address - Country:US
Mailing Address - Phone:918-683-0121
Mailing Address - Fax:918-683-6650
Practice Address - Street 1:251 SOUTH 37TH STREET
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4919
Practice Address - Country:US
Practice Address - Phone:918-683-0121
Practice Address - Fax:918-683-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16851207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100180620AMedicaid
OK300522334OtherMEDICARE GROUP
OK0004110411OtherAETNA
OK491607790001OtherBLUE CROSS BLUE SHIELD
OK040004806OtherUNITED HEALTHCARE
OK300522334OtherMEDICARE GROUP