Provider Demographics
NPI:1336276153
Name:JACK E METCALF MD INC
Entity Type:Organization
Organization Name:JACK E METCALF MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-751-7682
Mailing Address - Street 1:4140 W MEMORIAL RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8366
Mailing Address - Country:US
Mailing Address - Phone:405-751-7682
Mailing Address - Fax:405-751-7994
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 116
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8366
Practice Address - Country:US
Practice Address - Phone:405-751-7682
Practice Address - Fax:405-751-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9732207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35035Medicare UPIN