Individual
JOHN S MUSILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4411 W GORE BLVD, SUITE A2, LAWTON, OK 73505
(580) 355-0575
(580) 248-1725
Mailing address
PO BOX 785, LAWTON, OK 73502
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4249
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246726402
MEDICARE ID
OK
Enumeration date
10/23/2006
Last updated
01/23/2009
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