Provider Demographics
NPI:1396713624
Name:ARCHER, ANN GRAY (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:GRAY
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-945-4710
Mailing Address - Fax:405-265-6308
Practice Address - Street 1:3330 NW 56TH
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-945-4710
Practice Address - Fax:405-265-6308
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK237762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00704890OtherMEDICARE RAILROAD
OK200022970AMedicaid
OK200022970AMedicaid
OKP00704890OtherMEDICARE RAILROAD
OKE63760Medicare UPIN