Provider Demographics
NPI:1265468490
Name:HOPE, ELLEN EAGLE (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:EAGLE
Last Name:HOPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14100 PARKWAY COMMONS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-6103
Mailing Address - Country:US
Mailing Address - Phone:405-270-0500
Mailing Address - Fax:405-270-0597
Practice Address - Street 1:14100 PARKWAY COMMONS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6103
Practice Address - Country:US
Practice Address - Phone:405-270-0500
Practice Address - Fax:405-270-0597
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK126892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100216890AMedicaid
OK12689OtherSTATE LICENCE
OKAE9341645OtherDEA
73-1453520OtherTIN
OK100216890AMedicaid