Provider Demographics
NPI:1477551323
Name:KOENEN MYERS, H PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:PETER
Last Name:KOENEN MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3733
Mailing Address - Country:US
Mailing Address - Phone:405-595-6282
Mailing Address - Fax:
Practice Address - Street 1:2512 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3733
Practice Address - Country:US
Practice Address - Phone:405-595-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23113OtherSTATE LICENSE
OK23113OtherSTATE LICENSE