Provider Demographics
NPI:1215826086
Name:SEGO, ERNEST LARRY III
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:LARRY
Last Name:SEGO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 N HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5208
Mailing Address - Country:US
Mailing Address - Phone:405-214-4777
Mailing Address - Fax:
Practice Address - Street 1:1420 N HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5208
Practice Address - Country:US
Practice Address - Phone:405-214-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist