Organization
PERRY FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D HARTWIG MD (PARTNER)
(580) 336-3529
Entity
Organization
Contact information
Practice address
505 14TH ST, PERRY, OK 73077
(580) 336-3529
Mailing address
505 14TH ST, PERRY, OK 73077
(580) 336-3529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
690730001007
BLUE CROSS BLUE SHIELD
OK
Enumeration date
08/28/2006
Last updated
08/22/2020
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