Provider Demographics
NPI:1427035419
Name:MATTHEWS, MARCIA KAY (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:KAY
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 B ST SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6808
Mailing Address - Country:US
Mailing Address - Phone:918-542-5551
Mailing Address - Fax:918-542-1555
Practice Address - Street 1:30 B ST SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6808
Practice Address - Country:US
Practice Address - Phone:918-542-5551
Practice Address - Fax:918-542-1555
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124760AMedicaid
OKAAA1909Medicare PIN
OK100124760AMedicaid