Provider Demographics
NPI:1780752980
Name:KILBURY, MERLIN JOE III (MD)
Entity type:Individual
Prefix:
First Name:MERLIN
Middle Name:JOE
Last Name:KILBURY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6830
Mailing Address - Country:US
Mailing Address - Phone:918-540-7573
Mailing Address - Fax:918-540-7590
Practice Address - Street 1:200 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6830
Practice Address - Country:US
Practice Address - Phone:918-540-7573
Practice Address - Fax:918-540-7590
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9907207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699440MMedicaid
OK200059690AMedicaid
OK100073730AMedicaid
OK200059690AMedicaid
OK402362Medicare PIN