Individual
DR. THEODORE ARTHUR MICKLE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO, MPH
Contact information
Practice address
921 NE 13TH ST, VA MEDICAL CENTER, OKLAHOMA CITY, OK 73104-5007
(405) 736-2305
(405) 456-1623
Mailing address
4204 NW 143RD ST, OKLAHOMA CITY, OK 73134-1725
(405) 748-3925
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29986
NC
Other
Enumeration date
10/12/2005
Last updated
03/25/2010
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