Provider Demographics
NPI:1194758540
Name:MCTAGUE, JEROME ANTHONY (MD, JD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ANTHONY
Last Name:MCTAGUE
Suffix:
Gender:M
Credentials:MD, JD
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Mailing Address - Street 1:2200 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5800
Mailing Address - Country:US
Mailing Address - Phone:419-461-1057
Mailing Address - Fax:
Practice Address - Street 1:2200 N CLASSEN BLVD
Practice Address - Street 2:SUITE 1403
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5800
Practice Address - Country:US
Practice Address - Phone:419-461-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30495207P00000X
MO2014015848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine