Provider Demographics
NPI:1801896709
Name:EMERSON, NOEL W (DO)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:W
Last Name:EMERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:795 S BIG BEN RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-4501
Mailing Address - Country:US
Mailing Address - Phone:580-889-6399
Mailing Address - Fax:580-889-6659
Practice Address - Street 1:1510 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3246
Practice Address - Country:US
Practice Address - Phone:580-889-6621
Practice Address - Fax:580-889-3602
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096460CMedicaid
OK100096460CMedicaid