Provider Demographics
NPI:1447253141
Name:SOPER, MICHAEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:SOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:329 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4945
Mailing Address - Country:US
Mailing Address - Phone:918-687-9998
Mailing Address - Fax:918-687-4135
Practice Address - Street 1:329 S 38TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4945
Practice Address - Country:US
Practice Address - Phone:918-687-9998
Practice Address - Fax:918-687-4135
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK11682207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100094790AMedicaid
OK180000229OtherRAILROAD MEDICARE
OK1447253141Medicare NSC
OK180000229OtherRAILROAD MEDICARE
OK1316069008Medicare PIN