Provider Demographics
NPI:1881996155
Name:JOHN R. DOSSER, M.D., INC. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JOHN R. DOSSER, M.D., INC. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-942-8515
Mailing Address - Street 1:3617 NW 58TH ST
Mailing Address - Street 2:#200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4487
Mailing Address - Country:US
Mailing Address - Phone:405-942-8515
Mailing Address - Fax:405-943-1795
Practice Address - Street 1:3617 NW 58TH ST
Practice Address - Street 2:#200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4487
Practice Address - Country:US
Practice Address - Phone:405-942-8515
Practice Address - Fax:405-943-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12685207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100610AMedicaid