Individual
DR. JOHN P AGENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1015 E CHOCTAW AVE, SALLISAW, OK 74955-5011
(918) 774-0034
(918) 774-0650
Mailing address
PO BOX 776075, CHICAGO, IL 60677-6075
(918) 774-0034
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3341
OK
207R00000X
Internal Medicine Physician
E-1152
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110222385
RAILROAD MEDICARE
—
05
—
145013003
—
AR
Enumeration date
06/01/2006
Last updated
12/20/2018
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