Provider Demographics
NPI:1447550827
Name:MARY E. WEARE, M.D., PLLC
Entity type:Organization
Organization Name:MARY E. WEARE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-336-3277
Mailing Address - Street 1:300 S WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-4038
Mailing Address - Country:US
Mailing Address - Phone:918-336-3277
Mailing Address - Fax:918-336-0178
Practice Address - Street 1:300 S WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4038
Practice Address - Country:US
Practice Address - Phone:918-336-3277
Practice Address - Fax:918-336-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK134462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100209770AMedicaid