Provider Demographics
NPI:1912218868
Name:MIGUEL SABEDRA PLLC
Entity Type:Organization
Organization Name:MIGUEL SABEDRA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:REY
Authorized Official - Last Name:SABEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-658-3203
Mailing Address - Street 1:501 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-1807
Mailing Address - Country:US
Mailing Address - Phone:580-658-3203
Mailing Address - Fax:580-658-8026
Practice Address - Street 1:501 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-1807
Practice Address - Country:US
Practice Address - Phone:580-658-3203
Practice Address - Fax:580-658-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100131510BMedicaid
OKOK17356OtherOKLAHOMA STATE LICENSE
OKOK17356OtherOKLAHOMA STATE LICENSE
OK100131510BMedicaid