Provider Demographics
NPI:1629240148
Name:METCALF DERMATOLOGY,PLC
Entity Type:Organization
Organization Name:METCALF DERMATOLOGY,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-372-7575
Mailing Address - Street 1:PO BOX 1537
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-1537
Mailing Address - Country:US
Mailing Address - Phone:405-372-7575
Mailing Address - Fax:405-533-1093
Practice Address - Street 1:1329 S SANGRE RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1854
Practice Address - Country:US
Practice Address - Phone:405-372-7575
Practice Address - Fax:405-533-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23999174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty