Provider Demographics
NPI:1750301479
Name:GUTHRIE, WILLIAM J (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1200 W CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4624
Mailing Address - Country:US
Mailing Address - Phone:918-485-1210
Mailing Address - Fax:918-485-9994
Practice Address - Street 1:1200 W CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4624
Practice Address - Country:US
Practice Address - Phone:918-485-1210
Practice Address - Fax:918-485-9994
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2617207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D38541Medicare UPIN