Individual
DR. MATTHEW MARCUS MCTAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3315 KETHLEY RD, SHAWNEE, OK 74804-9638
(405) 273-5801
(405) 878-3794
Mailing address
3315 KETHLEY RD, SHAWNEE, OK 74804-9638
(405) 273-5801
(405) 878-3794
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4930
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210410701
—
TX
01
—
P00803385
RAILROAD MEDICARE
TX
Enumeration date
11/21/2008
Last updated
09/19/2023
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