Provider Demographics
NPI:1144236696
Name:ATWELL, DWAYNE H (MD)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:H
Last Name:ATWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16851207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100180620AMedicaid
OK100180620AMedicaid