Provider Demographics
NPI:1386672913
Name:CLEMENTS, MARCHEL WORD (DO)
Entity Type:Individual
Prefix:
First Name:MARCHEL
Middle Name:WORD
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 S 109TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5822
Mailing Address - Country:US
Mailing Address - Phone:918-392-1400
Mailing Address - Fax:918-392-1488
Practice Address - Street 1:4812 S 109TH EAST AVE
Practice Address - Street 2:STE. 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5826
Practice Address - Country:US
Practice Address - Phone:918-236-4580
Practice Address - Fax:918-236-4587
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2945207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100150800AMedicaid
5454227OtherCIGNA
5932735OtherAETNA
5454227OtherCIGNA
OK100150800AMedicaid