Provider Demographics
NPI:1568643997
Name:OKLAHOMA WEST PHYSICIANS GROUP
Entity Type:Organization
Organization Name:OKLAHOMA WEST PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:HUSER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:580-772-3331
Mailing Address - Street 1:3725 LEGACY ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096
Mailing Address - Country:US
Mailing Address - Phone:580-772-3331
Mailing Address - Fax:580-774-1451
Practice Address - Street 1:3725 LEGACY ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5329
Practice Address - Country:US
Practice Address - Phone:580-772-3331
Practice Address - Fax:580-774-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100252270AMedicaid
OK100745110BMedicaid
OK100252270AMedicaid