Basic Information
| Provider Information | |||||||||
| NPI: | 1144233867 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAURICE ERNEST CORMAN M D PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PIEDMONT FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 W MEMORIAL RD | ||||||||
| Address2: | SUITE #141; ATTN: BECKY | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059365811 | ||||||||
| FaxNumber: | 4059365810 | ||||||||
| Practice Location | |||||||||
| Address1: | 63 GOODER SIMPSON BLVD. | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053730380 | ||||||||
| FaxNumber: | 4053730457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 11/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | CORMAN | ||||||||
| AuthorizedOfficialFirstName: | MAURICE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4053730375 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 23210 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.