Basic Information
| Provider Information | |||||||||
| NPI: | 1548200223 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 RIDGECREST DR | ||||||||
| Address2: | #L154 | ||||||||
| City: | ELK CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736441947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803030225 | ||||||||
| FaxNumber: | 5802255423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 W 1ST ST | ||||||||
| Address2: | SUITE 107B | ||||||||
| City: | ELK CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736443133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802259988 | ||||||||
| FaxNumber: | 5802255423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 24124 | OK | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00209413 | 01 | OK | RAILROAD MEDICARE | OTHER |