Basic Information
| Provider Information | |||||||||
| NPI: | 1538353149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUN | ||||||||
| FirstName: | DONGXU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1370 N INTERSTATE DR | ||||||||
| Address2: | SUITE 154 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730723376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053076668 | ||||||||
| FaxNumber: | 4057016170 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 N JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754552338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035776000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 28082 | OK | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | N7972 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 28082 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 220590807 | 05 | TX | MEDICAID | 75-2616977-042 | 01 | TX | TRICARE | OTHER | P01105249 | 01 | TX | RAIL ROAD | OTHER | 8DK100 | 01 | TX | BCBS | OTHER |