Provider Demographics
NPI:1962412569
Name:MUSE, GENE L (MD)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:L
Last Name:MUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:STE 1001
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9350
Mailing Address - Country:US
Mailing Address - Phone:405-787-7678
Mailing Address - Fax:405-751-3367
Practice Address - Street 1:4200 W MEMORIAL ROAD
Practice Address - Street 2:STE 1001
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-787-7678
Practice Address - Fax:405-751-3367
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK11348207XX0005X
OK11348OK207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112730AMedicaid
OK200061670AMedicaid
OK100112730AMedicaid
D35082Medicare UPIN