Provider Demographics
NPI:1992996789
Name:DOUGLAS MENZ, D.O. P.C.
Entity type:Organization
Organization Name:DOUGLAS MENZ, D.O. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-391-2970
Mailing Address - Street 1:20912 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-6439
Mailing Address - Country:US
Mailing Address - Phone:405-391-2970
Mailing Address - Fax:405-391-2972
Practice Address - Street 1:20912 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-6439
Practice Address - Country:US
Practice Address - Phone:405-391-2970
Practice Address - Fax:405-391-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3408261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522008OtherMEDICARE GROUP NUMBER
OK800522008OtherMEDICARE GROUP NUMBER