Provider Demographics
NPI:1306983218
Name:FIDEL, MARCUS JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:JAMES
Last Name:FIDEL
Suffix:
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 1:7122 S SHERIDAN RD
Mailing Address - Street 2:SUITE 2 -175
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2748
Mailing Address - Country:US
Mailing Address - Phone:918-619-4600
Mailing Address - Fax:
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2553
Practice Address - Country:US
Practice Address - Phone:918-619-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK24062OtherOK STATE LICENSE NUMBER