Basic Information
| Provider Information | |||||||||
| NPI: | 1548202807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORMAN | ||||||||
| FirstName: | MAURICE | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14024 QUAIL POINTE DR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054198465 | ||||||||
| FaxNumber: | 4054197745 | ||||||||
| Practice Location | |||||||||
| Address1: | 63 GOODER SIMPSON BLVD | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730789215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053730380 | ||||||||
| FaxNumber: | 4053730457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 23210 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200093380A | 05 | OK | MEDICAID |