Organization
PHILLIP DOERNER JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP DOERNER MD (OWNER)
(405) 602-8100
Entity
Organization
Contact information
Practice address
3100 SW 89TH ST, OKLAHOMA CITY, OK 73159-7900
(405) 602-8100
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100827590C
—
OK
01
—
DF2245
RR MEDICARE
OK
Enumeration date
03/27/2008
Last updated
07/21/2022
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