Active NPI
Suphong Techathuvanan, MD
- Surgery Physician
- Claremore, OK
National Provider Identifier
1376552695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 30243
- Practice address
- 101 S Moore Ave
Claremore, OK 74017-5047 - Phone
- (918) 342-6200
- Fax
- (918) 342-6610
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 30243 | NC | Primary |
Addresses
Primary practice location
101 S Moore Ave
Claremore, OK 74017-5047
Mailing address
9645 E Clover Creek Dr
Claremore, OK 74017-1489
Phone (918) 342-6200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30243 | NC | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376552695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9645 E CLOVER CREEK DR",
"city": "CLAREMORE",
"state": "OK",
"postal_code": "740171489",
"telephone_number": "918-342-6200",
"fax_number": "918-342-6610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 S MOORE AVE",
"city": "CLAREMORE",
"state": "OK",
"postal_code": "740175047",
"telephone_number": "918-342-6200",
"fax_number": "918-342-6610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TECHATHUVANAN",
"first_name": "SUPHONG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "30243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Claremore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.