Provider Demographics
NPI:1790747293
Name:ARCHER, JAMES S (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:ARCHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1211 S SHARTEL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170
Mailing Address - Country:US
Mailing Address - Phone:405-235-8008
Mailing Address - Fax:
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-235-8008
Practice Address - Fax:405-239-2403
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2015-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK13089208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106990AMedicaid
OK100106990AMedicaid
OK246705007Medicare PIN
OK5390430010Medicare NSC
OKE10813Medicare UPIN
OK$$$$$$$$$007OtherBSBS