Provider Demographics
NPI:1922196369
Name:MURCH, THERESA A (DO)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:MURCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE DEBELL
Mailing Address - Street 2:BLDG A
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-331-2406
Mailing Address - Fax:918-331-2407
Practice Address - Street 1:3400 FRAND PHILLIPS
Practice Address - Street 2:STE 401
Practice Address - City:BATLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-331-2406
Practice Address - Fax:918-331-2407
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4669207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200213590AMedicaid
OK200039950AMedicaid
OKP00799207OtherRR MEDICARE
OKDE3229OtherGROUP RR MEDICARE
OKDE3229OtherGROUP RR MEDICARE
OK200039950AMedicaid
OK500522114Medicare PIN