Provider Demographics
NPI:1720036122
Name:AGTE, SUHAS DAMODAR (M D)
Entity Type:Individual
Prefix:DR
First Name:SUHAS
Middle Name:DAMODAR
Last Name:AGTE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 W GORE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6025
Mailing Address - Country:US
Mailing Address - Phone:580-357-8330
Mailing Address - Fax:
Practice Address - Street 1:5108 W GORE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6025
Practice Address - Country:US
Practice Address - Phone:580-357-8330
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23697207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG59208Medicare UPIN